What is Capsulitis?

Capsulitis is condition in which the joint capsule is inflamed. Ligaments surround your joints, including your toe joints, and help form a capsule. Joint capsules help your joints to function properly. A common problem in certain parts of your body, especially the shoulders and toes, capsulitis-related inflammation may cause significant discomfort. This health problem can, over time, lead to toe dislocation if it is not treated appropriately. In fact, capsulitis is sometimes referred to as pre-dislocation syndrome, and can manifest in people of all ages.


There can be a variety of causes of capsulitis. Most podiatrists and other healthcare providers believe that capsulitis is caused by unusual foot mechanics, that involve excessive weight-bearing on the ball of your foot, beneath your affected toe joint. Certain factors may increaseCauses of Capsulitis your likelihood of developing this problematic condition, including:

  • – Extreme bunion deformity
  • – A second toe that is longer than your first toe
  • – An unstable foot arch
  • – Tight calf muscles on your involved side
  • – Imbalance between the muscles on top of, and below your feet (extensors and flexors)
  • – Poor fitting shoes or improper shoe wear
  • – Regular use of footwear with an elevated heel and/or toe-spring

Conventional footwear may be the most common cause of capsulitis. High-heeled shoes can increase pressure on the ball of the foot, while sandals and flip-flops do not generally provide sufficient support to the foot, and can also increase the strain to the 2nd toe joint.Most shoes possess elevated toe boxes, or toe-spring, as a built-in design feature. Toe box elevation increases pressure under the capsules of your metatarsal joints. Because your second metatarsal bone is usually the longest in your 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 of most conventional footwear, force your big toe against your second toe, putting your big toe out of balance with its corresponding metatarsal bone.

In advanced stages of capsulitis, the supporting ligaments can weaken, and ultimately tear, producing drifting of the 2nd toe either toward the 1st or 3rd toe.  The bottom portion of the joint capsule is referred to as the plantar plate.  In severe and advanced cases of capsulitis, this structure usually must be surgically repaired.

Signs and Symptoms

Several distinct signs and symptoms commonly develop in people who have capsulitis, including:Typical joint that can be affected by Capsulitis

  • – Pain in your affected area
  • – Swelling around your involved joint capsule
  • – Redness of the skin overlying your affected joint
  • – A sensation like you are walking on a stone
  • – Nerve type symptoms (numbness, tingling, burning, and shooting pains into the toes)

Capsulitis painPainful calluses may form in some individuals 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 them. These calluses are commonly misdiagnosed as plantar warts, and they can occur under any of your metatarsal heads. Capsulitis induced calluses usually respond to metatarsal pads and cut outs. Cut outs are an orthotic technique that allows your more prominent metatarsal head, one of the structures most commonly affected by capsulitis to drop lower than your other metatarsal bones. This action helps balance your weight-bearing load, and decreases the pressure on your affected area.

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

What can be done?

If you have pain on the ball of your foot typical of capsulitis, or if you see your 2nd toe drifting, it is recommended that you see a podiatrist.  It is important to not ignore the pain of capsulitis, since if left untreated, it most certainly will advance to further instability of the joint.

Avoid shoes with Toe Spring and Tapered Toe Boxes
Avoid shoes with Toe Spring and Tapered Toe Boxes

If your symptoms are not severe, conservative treatment is usually indicated.  Proper footwear to help treat the condition, and activities to avoid, to lessen the contributors to your symptoms.  Prescription

Get fitted for Orthotics
Get fitted for Orthotics

anti-inflammatory medication may be needed to reduce the inflammation associated with capsulitis and cortisone injection may be used for some cases.

The most important thing however, is to be fitted for orthotics.  Most cases of capsulitis can be effectively treated conservatively.  But, if you have developed a severe hammertoe or cross-over toe as a result of advancement of the capsulitis, then surgery may be necessary.

Your feet mirror your general health . . . cherish them!

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