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CAPSULITIS AND CAPSULAR TEAR

Capsulitis is an inflammatory condition that can occur at any joint but most frequently affects the forefoot.  Although systemic disease can involved, most often too much pressure on that part of the foot is the cause.  The most common site is beneath the 2^nd metatarsal head.

The metatarsal bones carry our body weight.  The longer the metatarsal bone, the more weight it bears without help from the other metatarsals.  Over time, the soft tissue that surrounds the joint (called the capsule) can become painful.

A capsular tear can result from progressive degeneration, trauma or secondary to arthritic process.  Swelling is more likely to be present and pain is present on the plantar (bottom) and dorsum (top) of the joint when there is a tear. Crossover toes are almost always present when there is a tear.

Other names or similar foot conditions:

• Pressure metatarsalgia

Symptoms:

• Pain in forefoot that can be localized at the plantar aspect of one of the metatarsal joints (capsulitis) and on both plantar and dorsum (capsular tear)
• Symptoms most noticeable while barefoot on hard surfaces and/or in thin soled shoes

Signs to look for:

• Pain in forefoot that can be localized to the plantar aspect of one of the metatarsal joints (capsulitis) and on both plantar and dorsum (capsular tear)
• Symptoms most noticeable while barefoot on hard surfaces and/or in thin soled shoes
• Callus may be present at affected area
• Crossover toes (if a capsular tear)

Possible Causes:

• Genetic
• Results of synovitis, as in arthritis
• Injury

Goals:

• Medical treatment for systemic disease
• Take pressure off the affected joint

• Create optimal foot motion
• Improve gait

Solutions:

Arch Supports:

• Bio-Orthotics Winstep or Sundance exercising support with metatarsal lift

• Lower and thinner arch support with longitudinal and metatarsal support, such as the Bio-Orthotics Journey or Silhouette, for use when shoes cannot accommodate the Winstep or Sundance exercising support

• Use Plastazote cushion in shoe over arch support until symptoms recede

• Extra depth shoe with firm heel counter, full steel shank and rocker sole

• MBT physiological footwear

• Shoes with stretchable uppers where crossover toes are sensitive

• For exercise, wear shoes with titanium springs

• Wear pumps and high heels only as long as absolutely necessary

• Avoid going barefoot except on a minimal basis

Other: 

• Obtain medical diagnosis

• Spot stretching with ball and ring stretcher

• Toe cushioning and straightening devices, such as toe separators, toe straighteners, toe gel caps, toe crests, etc.

Activities:

• Alternate non-weight bearing exercising, such as swimming, with weight bearing exercising such as walking

• Regular callus filing with pumice device (leaving cutting of calluses to a physician only)