capsulitis

Capsulitis by definition is inflammation of a ligament. Anywhere in the body where two bones come together they form a joint; that is what allows movement within the skeletal system. (Your ankle bending up and down is movement of a joint.)

Surrounding the joint are the capsular ligaments, which act to keep the two bones lined up in approximation so that the joint can function in its optimal range. Ligaments are very tough tissue, almost leather like in texture.

The problem is that you have leather like structures trying to hold bone together (healthy bone has a tensile strength similar to low grade steel). If there is any stress placed on the joint from trauma, or abnormal biomechanical functioning you can be sure the “leather” is going to give out first before the “steel” does. This is what causes capsulitis.

Keep in mind that capsulitis can occur at any joint in the human body and even occurs in a number of places on the foot, but we are going to discuss the classic “capsulitis” as seen in the foot.

Below is a skeletal model of the bottom of the forefoot. Note the red checkered area; that is the plantar ligament that is part of the capsular ligament which actually surrounds the whole joint. I have highlighted the plantar ligament because that is the part of the capsular ligament that is most affected in capsulitis.

Activities such as stooping while gardening, constantly climbing ladders, doing work low to the ground like electrical or plumbing work, wearing very high heel shoes, all cause excessive bending of the toes at the level of the arrows. The constant excessive bending of these toes will eventually cause the ligaments to overstretch become inflamed and then begin to hurt. Keeping with my ongoing theme throughout this site; once you have a foot injury, walking on it just re-injures an injured area and thus increases the time it takes for the area to get better, if at all.

Typically a patient will present to the office complaining of pain in the forefoot, probably not relating any specific history of trauma, but the pain is just an ongoing nagging type pain. Many times the patient will have neuroma type symptoms. Click here for more information on Mortons neuroma as a source of foot pain. If you look at the site of Mortons neuroma and capsulitis you can easily see how they can be misinterpreted.

An experienced foot specialist should be able to differentiate between the two conditions. Many practitioners not totally familiar with foot pathology will come up with the wrong diagnosis.

The good news is some of the conservative treatments for neuroma will also help capsulitis. A cortisone injection should help both as will oral anti-inflammatory medication, for short duration only.

Avoiding high heels and boat shoes or any shoe with very flimsy soles should also help as well as avoiding activities which seem to exacerbate the problem.

In individuals where the pain improves but does not “go away” many times I will put them in prescription orthotics with a built in metatarsal pad that basically lifts the metatarsal bone so there is not so much stretching of the plantar capsule as the patient walks.

People that have rigid hammertoes are more prone to capsulitis because the nature of the hammertoe deformity itself stretches the ligament. In these cases if all else fails, surgical correction of the hammertoes can be very rewarding.

Lastly, sometimes a variation in the normal foot architecture of the metatarsal bones may cause a capsulitis with none of the other precipitating factors present. Usually a prescription orthotic will help these individuals as well. In instances where an orthotic does not help, surgical remodeling of the metatarsal bone may be necessary.