Common Problems


Capsulitis: Inflammation of a joint capsule.

General Info

Ligaments surround joints, including the toe joints, and help form joint capsules. Joint capsules help protect the joints and allow them to function properly. Capsulitis—inflammation of a joint capsule—is a common problem in certain parts of the body, especially the shoulders and feet, and may cause significant discomfort. This health problem can, over time, lead to toe dislocation if it’s not treated properly. In fact, capsulitis is sometimes called pre-dislocation syndrome. Capsulitis occurs in people of all ages.

Certain parts of the foot may be more likely to develop capsulitis than others. Some of the most common joint capsules to experience this ligamentous inflammation are the ones surrounding the metatarsophalangeal (MTP) joints at the ball of the foot. Each foot has five MTP joints that connect the toe bones, or phalanges, with their corresponding metatarsal bones—long, thin bones located in the midfoot.

The most common MTP joint capsule to develop capsulitis is the one that connects the second metatarsal bone with the second set of phalanges. Problems with this capsule, especially inflammation, are particularly common because of the excessive pressure placed on this joint during weight-bearing activities. Capsulitis may be difficult to diagnose because of the tendency for other structures in the forefoot to also become inflamed.

Signs & Symptoms

Common signs and symptoms associated with capsulitis include:

  • Pain in the affected area
  • The sensation of walking on a stone
  • Swelling around the involved joint capsule
  • Redness of the skin overlying the affected joint

Painful calluses may form in some cases if capsulitis becomes a chronic health problem. A person who develops calluses may feel as though the callus has a core or seed inside of it. These calluses are commonly misdiagnosed as plantar warts, and they can occur under any of the metatarsal heads. Capsulitis-related calluses usually respond to metatarsal pads and cutouts. Cutouts are an orthotic technique that allows the more prominent metatarsal head—the structure most commonly affected by capsulitis—to drop lower than the other metatarsal bones. This action helps balance the weight-bearing load and decreases pressure on the ball of the foot.

Some people with this condition also experience nerve symptoms caused by swelling. Bursitis—inflammation of fluid-filled sacs located in the forefoot—is another health problem that may be associated with capsulitis or confused with this condition.

Possible Causes

Most foot health experts believe that capsulitis is caused by aberrant, or unusual, foot mechanics that involve excessive weight-bearing on the ball of the foot, beneath the affected toe joint. Certain factors may increase a person’s likelihood of developing capsulitis, including:

  • An unstable foot arch
  • Extreme bunion deformity
  • Tight calf muscles on the involved side
  • A second toe that is longer than the first toe
  • Regular use of footwear with an elevated heel and/or toe spring
  • An imbalance between the muscles and tendons on the top and bottom of the foot (flexors and extensors)

Conventional footwear may be the most common cause of capsulitis. Most shoes possess elevated toe boxes, or toe spring, as a built-in design element. Toe spring increases pressure on the MTP joint capsules. Because the second metatarsal bone is usually the longest in the foot, it performs more than its normal share of weight bearing, and it can become inflamed and painful. Tapering toe boxes—another problematic design feature built into most conventional footwear—is another factor contributing to capsulitis. Tapering toe boxes force the big toe toward the second toe, putting the big toe out of balance with its corresponding metatarsal bone and destabilizing the main foot arch.

Helpful Strategies

Capsulitis often responds to conservative, non-surgical treatments. This condition is best treated in its early stages to help improve the affected joint’s stability, reduce pain and other symptoms, and resolve the root cause of the problem. Common natural treatment approaches for this health problem include:

  • Ice: Icing the affected area can minimize pain and swelling.
  • Rest: Reducing weight-bearing activities can help control symptoms.
  • Taping or Splinting: Taping helps realign the involved toe and prevents the toe from drifting.
  • Anti-Inflammatory Agents: Taking certain nutritional supplements can help reduce pain and swelling.
  • Stretching: Gentle stretching is important for those who have tight calf muscles or a foot flexor/extensor tendon imbalance. The Toe Extensor Stretch may be particularly helpful.
  • Shoe Therapy: Wearing shoes with a completely flat sole from heel to toe and wide toe boxes may be most helpful, as they help take focal pressure off the ball of the foot and enable natural arch support.
  • Metatarsal Pads and Toe Spacers: Metatarsal pads can help return the forefoot fat pad to its intended (and protective) location under the metatarsal heads. Correct Toes is another helpful treatment tool for capsulitis, as it encourages proper alignment of the metatarsal bones and forefoot structures and helps distribute bodyweight more evenly across the forefoot.

Always consult your physician before beginning any capsulitis treatment plan.

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