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Capsulitis

Capsulitis is inflammation of the metatarsal head, and is typically the result of a combination of abnormal biomechanics and wearing shoes that do not offer enough support or shock absorption.

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A person massaging their forefoot.

About Capsulitis

Every joint in the body is held together by a collection of ligaments, and these ligaments form a 'joint capsule'. 

When walking in footwear that is not adequately supportive or not cushioned enough for your needs, then you can bruise the collection of ligaments, and even sometimes stretch them due to the lack of support. 

This can lead to pain in the joint capsule and inflammation.

Symptoms of Capsulitis

Symptoms of Capsulitis are:

  • Pain at the bottom of the knuckle joint under foot

  • Swelling or bruising

  • Feeling like there is a pebble in your shoe

If the swelling is significant, the symptoms can mimic a Morton's Neuroma due to compression of the nerve that supplies the toes:

  • Numbness

  • Burning

  • Tingling

  • Shooting pains or electric shocks

A shoe on it's side with pebbles falling out of it.
A graphic rendering of the muscles and ligaments inside a foot.

What else could it be?

Despite the relatively small amount of space at the front of the foot, there is quite a lot going on, especially due to the amount of force that goes through this region. Other differential diagnoses for Morton's Neuroma include:

  • Morton's Neuroma

  • Stress Fractures

  • Plantar plate injuries

  • Flexor tendinitis

  • Sesamoiditis

How is a Capsulitis diagnosed?

Capsulitis is often misdiagnosed as a Morton's Neuroma, however the subtle differences in a clinical history can be enough to differentiate the two conditions. 

Imaging that can be used for Capsulitis:

  • Ultrasound scans 

  • MRI Scans (can be particularly helpful for highlighting inflammation and differentiating)

  • X-rays can be used to rule out other issues, like fractures

    • X-rays can also give 'clues' about whether the foot's structure has a role in the development of capsulitis.​

A slice from a sagittal view of the foot from an MRI scan.
A person standing with their big toes lifted skywards off the ground. This is a type of exercise that might be given for someone with foot pain.

How is Capsulitis treated?

Capsulitis is typically caused by a mixture of biomechanical factors combined with the progressive effect of localised inflammatory processes.

Some of the treatments that are recommended include:

  • Stretching the calf muscles

  • Changing footwear

  • Use of anti-inflammatories

  • Orthotics and insoles

  • Manipulation and mobilisation of joints

  • Shockwave therapy

  • Steroid injections

How long does it take to cure Capsulitis?

Capsulitis is quite easily treated in that it follows a predictive pattern that if you allow the inflammation to settle, the pain goes away. 

However, if biomechanical factors remain untreated, or the offending footwear (or footwear types are returned to), then symptoms may return. 

Most patients, who follow the treatment plan carefully, can expect symptoms to resolve within 3 weeks, and are fully out of the woods within two months.

If symptoms return, then carefully assessing footwear or considering customised foot orthoses can be incredibly helpful. 

Lady running with her dog
Ready to say goodbye to your pain?

At Keep On Your Feet, we openly acknowledge that we cannot guarantee a cure for things: but we will work as hard as we can with you to help you reach your goals. 

If your symptoms fit the above, you will need to book a 'Foot Pain' consultation. This will be £95 and lasts approximately 60 minutes usually. If you need insoles, we'll give you some basic ones to try out (or some fancier ones and reduce their price!). 

This is a picture of Jeremy Ousey, director and podiatrist of Keep On Your Feet.

About the Author

Jeremy Ousey is the owner at Swansea's podiatry clinic: Keep On Your Feet. All the information found on this page was written by him (there's no AI or Chat-GPT here!), and has been carefully chosen to provide you with the information that you need to know about the condition. Jeremy has a Bachelor of Science in Podiatry, with honours, a Post-Graduate Certificate in Podiatric Sports Medicine, a Post-Graduate Diploma in Medical Ultrasound, and two Master's of Science degrees in the Theory of Podiatric Surgery, and Sports & Exercise Medicine. If you would like to know more about Jeremy, please click here.

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