hey everyone I want to talk today about peeing 
under the ball of the foot under this area here   there are a number of different causes pain in 
that area but what we're in talk about today is   somebody called capsulitis which is the most 
common cause of pain in this area now the if   you look at these joints are these called the 
metatarsal phalangeal joints and like all joints   these bones are held together by ligaments now 
the the ligaments that hold joints together are   called a joint capsule this is a joint capsule 
right here so if there's too much pressure on   these areas then those that capsule can become 
inflamed and damaged and the standard treatment   initially is to get pressure off it we might 
use an orthotic to get pressure off that area   but sometimes that tissue just stops healing the 
healing process itself stalled and we need to do   something to stimulate that healing so there's 
there's different ways to do it but probably one   of the more effective ways is something called 
shockwave therapy this is a shockwave machine   here it's called extra corporal or outside the 
body shockwave therapy in this handle is a little   bullet that goes back and forth and that bullet 
goes back and forth creates a pressure wave that   comes out the head here and when that is applied 
to tissue like a joint capsule it creates some   biologic changes in that tissue basically takes 
a non-healing tissue and stimulates a healing   response and a couple things occur number one is 
something called neovascularization or formation   of new blood vessels second thing is released 
or what are called growth factors these are   proteins that stimulate healing now as every 
treatment has it did this this term even has   advantages and disadvantages the advantage to 
it it's been shown on a lot of similar tissues   to be very effective as stimulating healing it 
can be 70 to 80 percent effective it's there's   no risk whatsoever no one's ever worse for 
having done shockwave therapy and it's for   the most part pretty painless the downsides are 
it's slow when it does work it takes about four   months to see the benefit for it from it and 
although it has been studied extensively on   similar tissue such as the joint of the shoulder 
there are no specific Studies on the metatarsal   phalangeal joint the other downside it's not 
covered by insurance it's not that expensive   but you're probably depending where you are in 
the country you're gonna spend between between   about four hundred and six hundred dollars for 
that treatment but it's a good non-invasive way   to stimulate healing and tissue that is not 
otherwise healing and certainly something   to think about if you're having ball of 
foot pain that's just not getting better