What is Capsulitis

So a very common condition that people will come in to any sports providers Offices is ball of the foot pain, in other words, pain under this location of the foot very nonspecific generic term for that as metatarsalgia, which just means pain under the ball of the foot. So there’s many many different reasons why people can have pain under the ball of the foot.

One of the most common is when the outer, covering of the joint known as the capsule gets inflamed or irritated, that’s known as Capsulitis, and the most common Capsulitis that I will see is typically under the long bone or the second metatarsal phalangeal joint. This joint right here people will come in and they’ll have pain directly when I push on the bone of the second and that’s that’s significant for several reasons.

What Causes Capsulitis

Most everybody’s foot that I’ve evaluated the second long bone is the longest. So when you, when you look at how Footwear is made for us, especially athletic footwear, it encourages an overloading of the ball of the foot. So the very first Footwear feature that should not be included in athletic shoes as there’s never been any scientific research to substantiate it is an elevated heel.

The moment you put an elevated heel on to any Footwear, you encourage an overloading of the ball of the foot and the reason why that becomes a problem for the capsules, particularly the capsule of the second long bone. Is it’s the longest.

So if you lift the heel and you focus more weight bearing on the front of the foot, typically most of that’s going to fall on the second. As if that’s not enough of an injurious Footwear design feature, most Footwear out there does no no number two to the capsule and that is toe spring.

Poorly Designed Shoes

So we’ve got the elevated heel, shoe designers put a generous amount of what’s called toe spring, and essentially, what that does is the fat pad that is supposed to stay under the ball of the foot goes where the toes go. So if the toes are flat on the ground like nature intended, the fat pad will be directly under the ball of foot, protecting and supporting that area. So as soon as we lift our heel as soon as we lift our toes, the fat pad now will reside up under the toes which are not even on the ground and that individual then go on to irritate the capsule.

The third thing is not only have we overloaded it, we’ve stretched it and pounded on it. The tapering of the toe box also squeezes so those three things that are built into shoes focus almost all of the weight-bearing pressure directly under that second long bone.

That individual will often times have a callus there or have been misdiagnosed as having a wart because of a thick growth of skin. That occurs because that area is basically bearing all of the weight-bearing load. So what we want to do is to assume that that second metatarsal is too long in some people. So often times people will be offered an operation to shorten the metatarsal.

They oftentimes will be given an orthotic device to try to partially immobilize the foot if they’re lucky, they will also be offered a metatarsal pad which resides in the metatarsal arch and will partially mitigate some of the weight-bearing load.

Capsulitis Prevention and Treatment

Let’s talk a little bit about prevention and conservation as that’s the way we prefer to treat things so looking again at the capsule, we want to avoid elevated heel on the shoe we want to avoid toe spring of the shoe.

We want to avoid taper of the shoe once we’ve got that individual into the proper shoe that’s going to let their foot reside where it belongs. Inside of their shoe.

We then begin the process of rehabbing their foot, since the capsule on the bottom typically will be stretched and irritated. We want to bring that irritated, capsular tissue, closer together, and so the way we do that is, we begin stretching the top of the capsule, and we do that by doing our toe extensor stretch, which is this stretch here, so we get them out of the injurious Foot where we do the toe extensor stretch.

We use a metatarsal pad, which you can clearly see what the metatarsal pad does to this joint level. And if you were to see from the bottom of the foot the fat pad went back in under as we loaded that metatarsal arch, so we stretched the top of the foot.

Get them into proper footwear. Put him at a tarsal pad into that proper footwear. Have them heat the capsule prior to activity have them ice the capsule at the end of the day or at the end of activity and many times those folks will go on to get well.

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