Capsulitis I think
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems.
Last June I started having pain and swelling at the base of the second toe. After a couple of months I got to a podiatrist who said I have capsulitis. I have had three cortisone shots. I last saw the podiatrist 6 weeks after the third shot (January). The shots helped and we both thought the problem would completely heal in 6 to 9 weeks. Its March 22 and I still have the swelling and discomfort when I walk more than a short distance. I'm 61 years old and I really miss walking for exercise. I get along fairly well at work, I just can't walk very far without swelling and sorness.
Is it time for me to go back to the podiatrist? Is this the kind of problem that may stay with me for a long time yet? How long does something like capsulitis take to heal? I would like to avoid surgery, but is surgery a likely option?
Thanks for the kind words regarding this site....I try.
Anyway, capsulitis sometimes requires more than just cortisone shots, because many times they may be nothing more than temporary and you certainly cannot keep going back for shots.
In most cases the problem with pain on the bottom of the foot is that you keep re-aggravating the problem by overstretching the capsular ligament and thus once again the pain.
What I normally do at this point is add an orthotic with a metatarsal pad (see my section on capsulitis) in an effort to upwardly raise the metatarsal which will keep the ligament from over-stretching. This and some short term anti-inflammatory medication should do the trick.
As far as surgery goes I would seek to avoid that because the goal of surgery is to break the metatarsal bone and elevate it. The problem here is that the end result can be mixed, anywhere from no improvement, to a non-union (fracture does not heal) to the formation of a painful callus on the adjacent metatarsal bones. This type of surgery was popular years ago and the reason it is not done as often anymore is because it has too high a failure rate. But, have your doctor discuss all your options and then come to some agreement on your next move.
Marc Mitnick DPM