Capsulitis is when a joint capsule is inflamed, it is also known as synovitis. Your joints are surrounded and supported by ligaments, this makes up a capsule. The joint capsules help joints to function correctly as the inside layer (synovial membrane) produces and oily liquid known as synovial fluid. This fluid lubricates the joints. When there is too much synovial fluid being produced, this could cause swelling in the joints. Inflammation from capsulitis can cause pain and discomfort. Anyone regardless of age can suffer from this condition.
How is Capsulitis Diagnosed
A Podiatrist will examine the foot thoroughly before diagnosing this condition.It is common to suffer from capsulitis especially in your toes. Under the second or third toes and the ball of the foot are the most common joints to be affected. Each foot has five metatarsophalangeal (MTP) joints that join the toe bones (phalanges) to the metatarsal bones, these are the thin, long bones found in the middle of your foot.
The metatarsophalangeal joint capsule that most commonly suffers from capsulitis is the one that joins the second metatarsal bone with the second set of toe bones (phalanges). Problems like inflammation are common to arise as increased amounts of pressure are put on the joint whilst carrying out activities. This condition is hard to diagnose as other biomechanical problems can lead to inflammation of the foot.
Causes of Capsulitis
Capsulitis is generally caused by excessive weight bearing, wearing the wrong kinds of shoes and the foot functioning poorly. The second and third metatarsals where the long bone joins the toes to the ball of the foot are the most stable. When we walk, the other metatarsals let the foot adapt to uneven surfaces. If these metatarsals are not working properly then the joint can suffer from inflammation and overload.
Some medical conditions such as arthritis, osteoarthritis and rheumatoid can also cause inflammation in the joints. Certain causes may increase your chance of suffering from this condition, such as:
The kind of footwear we wear these days might be the greatest cause of capsulitis. Shoes generally come with raised toe boxes. A raised toe box intensifies the pressure under the MTP joint capsule. As the second metatarsal bone is generally the longest bone in the foot, it carries more than its fair share of weight, thus becoming sore and inflamed. Shoes also have tapering toe boxes which make the big toe push against the second toe. This changes the correct position of the metatarsal bone and causes it to be out of balance.
Women who wear small, tight, narrow shoes and high heels tend to suffer from capsulitis more than men. These kinds of shoes tend to put more pressure on the joints thus leading to problems.
Some of the symptoms people experience who suffer from this condition are:
It is very common for people to ignore pain in the foot and wait for it to go away by itself. Commonly the pain increases and the joints in the toes bend. By the time the pain goes away the damage will already be done and the toe will be deformed and harder to treat. This will lead to more complications and probably surgery.
Some people who suffer from capsulitis may increase the chances of calluses forming. If a callus forms, it may feel like the callus has something hard inside it. Sometimes these calluses are wrongly diagnosed as plantar warts. Using a metatarsal pad should help these calluses and using orthotics to decrease the pressure on the affected area. Bursitis where the fluid filled sacs found under the foot are inflamed is another condition which is sometimes wrongly diagnosed for people who are suffering from capsulitis.
Treatment for Capsulitis
There are many ways to treat capsulitis. It is best to treat it in the early stages before other complications set in. As time goes on the pain will increase as will the damage to the joint. A podiatrist will be able to find the main reason that’s causing this condition and treat it adequately. Usually it is treated by:
Visiting our Podiatrists
If symptoms do not start to improve then visit one of our Podiatrists. A Podiatrist will be able to:
The vast majority of capsulitis cases affecting the 2nd Metatarsophalangeal Joint (MTPJ) will settle if the patient has been compliant and rested the foot and worn running trainers with the orthotics.
If however, the patient continues to experience significant discomfort despite being compliant, then we would strongly urge the patient to consider a Cortico-steroid injection into the affected joint. The steroid solution (Methyl-prednisalone) once in the joint will settle the inflammation within it. Do not confuse a steroid injection with taking steroid tablets. A steroid injection in most cases has no long term undesirable side effects on the body and is perfectly safe.
A steroid injection is a commonly undertaken treatment at our practice, particularly for capsulitis and can be very effective in relieving the discomfort. The injection is quick and simple to undertake with minimal discomfort (the area is numbed with a local anaesthetic first).
Orthotics in the shoes can help the foot stay in its correct position. Using orthotics is not a cure but will be needed as the extra padding will support the foot in the right place. A cortisone injection will help ease pain but if you continue to walk and put weight on it then the joint capsule could rupture again. It is recommended to have the foot immobilised first then to have an injection.
In some cases surgery may be necessary. If you suffer from a hammer toe deformity or a bunion then they will need correcting through surgery.
If the metatarsal is too long then it can be shortened but not without risk. If surgery is required for a ruptured capsule then it will have to be carried out in the early stages before treatment for a toe deformity can be fixed. There are many complications and risks involved when it comes to foot surgery which your Podiatrist will discuss with you in detail.
View more information including costs click here