Capsulitis is a painful condition in the ball of the foot that can progress over time. But if treated early with some simple interventions, you may be able to avoid chronic pain or surgery.

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The human foot is an amazing structure. It’s comprised of 26 bones, 33 separate joints, and a litany of muscles, tendons, and ligaments. This complicated network of connections — both stable and mobile— bears the full weight of our bodies and allows for locomotion.

There are various joint-related afflictions that are relatively common in the foot, and understanding exactly which part of the foot may be the source of pain can be paramount to knowing how to treat the pain.

For instance, the four smaller toes (excepting the big toe, or “great toe”) each have three joints. Depending on which joint is afflicted, the smaller toes could be affected by claw toe, hammer toe, or mallet toe. If the joint affected is at the ball of the foot, the cause of pain could be capsulitis of the foot.

Capsulitis of the foot, also known as metatarsal phalangeal joint (MPJ) capsulitis or metatarsophalangeal (MTP) synovitis, occurs almost exclusively in the second toe, next to the great toe. The dense ligament structure at the joint, known as the capsule, becomes inflamed, and this condition is called capsulitis.

Most often, capsulitis affects the second toe, although occasionally, it can affect the third toe, causing pain in the ball of the foot under the affected toe.

It’s often confused with Morton’s Neuroma, which can affect the same general area, but is caused by compressed nerves. Capsulitis, on the other hand, is caused by ligament inflammation.

Capsulitis is characterized by pain in the ball of the foot, which is often compared to feeling like there is a pebble in the shoe at the ball of the foot. Other symptoms include swelling and redness in the ball of the foot, pain when walking, pain when barefoot, and discomfort in shoes.

If allowed to progress without intervention, capsulitis can cause other issues, such as callus formation under the affected joint and hammer toes.

Prolonged capsulitis can also cause the second toe to creep slowly toward the big toe, eventually crossing over it. This is called crossover toe and is a painful, progressive condition that can eventually cause dislocation. If capsulitis is diagnosed, it’s important to intervene as early as possible to prevent conditions like crossover toe.

Capsulitis can have various causes, such as:

  • trauma to the foot, particularly near the joint in question
  • poor foot mechanics
  • chronic stress on or overloading of the joint
  • prolonged use of footwear like high heels or flip flops
  • conditions such as rheumatoid arthritis or osteoarthritis
  • deterioration of the plantar plate complex — a hammock-like ligament supporting the MTP joint

A person may also have a higher chance of developing capsulitis due to the anatomical structure of the foot such as Morton’s toe or bunions (hallux vagus).

A doctor can diagnose capsulitis by examining the foot and maneuvering the toe in various planes of motion to determine that the pain is ligamental rather than nerve pain. Your doctor may order a vertical stress test or X-rays to confirm a diagnosis.

Surgery is not the first and best option for capsulitis. There are many noninvasive methods that can provide relief.

Treating capsulitis without surgery may involve:

  • Rest. If excessive athletic efforts have led to the condition, simply getting off the foot to allow the inflammation to subside may be enough.
  • Improving mechanics of the foot. This could involve physical therapy, as well as stretching tight muscles and strengthening weak muscles of the foot.
  • Orthotics. Getting an insert can help correct the biomechanics of the foot to reduce pressure.
  • Splinting. Bracing the toes can help alignment and prevent crossover.
  • Avoiding high heels and flip-flops. Narrow shoes, shoes that put excess pressure on the ball of the foot, and shoes with flimsy soles will likely aggravate the affected area.
  • Ice and elevation. Managing the inflammation will often bring relief.
  • Anti-inflammatory medications. These include over the counter nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or naproxen, or steroid injections.

Splinting the toes

There are a variety of products available for toe splinting. Most are very affordable, so you can try different ones to see what works for you.

Some people experience significant relief simply by using co-flex tape to bind the second and third toes together while exercising. Others like a softer insert for long-term wear.

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When is surgery recommended for capsulitis?

When nonsurgical intervention does not provide the intended relief or allow for continued mobility, surgery might be recommended. If the capsulitis creates crossover toe, surgery might be required to prevent or fix a dislocated joint. Surgery will generally involve shortening the elongated metatarsal bone to properly align the joints.

What does capsulitis feel like?

Capsulitis feels like pain in the ball of the foot, often described as feeling like there’s a bump or bruise at the bottom of the foot, as if you had a pebble in your shoe. It is generally progressive throughout the day and will be alleviated when you are off your feet.

How is capsulitis different than a neuroma?

Compared with Morton’s Neuroma, capsulitis will be felt at the base of the toe, as opposed to the space in between the toes. Neuromas are caused by nerves, whereas capsulitis is ligament inflammation at the joint.

How long does capsulitis take to heal?

If taken seriously, including rest, orthotics, and corrective measures, capsulitis may heal within 6 weeks to 3 months.

Will capsulitis go away?

If no changes are made, capsulitis can return or worsen. If a person is structurally prone to capsulitis, or if their foot mechanics are not changed, it can become a chronic problem. Treating the condition early can prevent surgical intervention later in life.

Capsulitis of the foot can occur as a result of anatomical predisposition, overuse, and certain footwear habits. Intervention is easy and at low cost if it is caught early.

However, if left unchecked, capsulitis can lead to crossover toe, a condition that’s at best uncomfortable and at worst can lead to joint dislocation and require surgery.

Taking good care of your feet by keeping them strong and mobile is a good start. Good footwear practices like minimizing high heel and flip flop use can help. Finally, taking simple interventions at the first sign of pain at the ball of the foot can keep you moving comfortably for many years to come.