What is capsulitis?
Capsulitis is inflammation of the structure that surround the toe joints (joint capsule). The joint capsule is a fluid-filled outer covering that joins two bones together.
Capsulitis most commonly affects your 2nd toe but can affect other joints in your forefoot and is often associated with a bunion.
How common is capsulitis?
Capsulitis of toe joints is seen as a common condition of the forefoot and can occur at any age.
Causes
What are the risk factors for developing capsulitis?
Capsulitis can occur from multiple factors:
- Weight: If you have a higher than average BMI you are more at risk.
- Strength: poor strength within the core foot muscles and lower limb.
- Footwear- soft, flexible soled footwear provide little support in the forefoot which can increase the stresses going through the small joints of the foot. Wearing footwear with a high heel also increases the stress on these tissues.
- Altered Foot Function – The presence of existing foot deformities such as hallux valgus (bunions), a short 1st toe, flat feet or hammertoe can all lead to overloading within these joints.
- Other Medical Conditions– Osteoarthritis and many inflammatory joint diseases (e.g. rheumatoid or psoriatic arthritis) affect the small joints in the foot making them more vulnerable to this condition.
- Sporting Activities – Certain sporting activities increase the load on these small joints such as running and activities on uneven surfaces
- Occupation – Certain occupations may lead to greater strain on these joints.
Symptoms
The most common symptoms of capsulitis include:
- Pain in the ball of the foot or base of affected toe.
- Pain, swelling and redness around the toe joint due to joint inflammation.
- Reduced strength within the affected toe.
- Difficulty walking/weight bearing
- In some cases, swelling can irritate nerves and cause altered sensation.
How long will it take to get better?
It depends on the severity of the inflammation and underlying cause of the condition – it can take up to several months. However with exercises and lifestyle changes you may see improvements in your pain and walking earlier and help prevent a deterioration of your injury.
Treatment options
What can I do to help my capsulitis?
Treatment is aimed at reducing the stress/ load through the affected joint to allow heal and improving strength around the affected joint.
Changes in lifestyle can also be helpful to aid in your recovery. The one person who can help you manage your symptoms is you.
Footwear
One of the most important changes you can make is to your footwear.
- Avoid walking in bare feet until your pain has resolved
- Avoid high heeled shoes or shoes with a flexible sole as these place increased stress on the joints of the forefoot.
- Avoid shoes which cause you to claw your toes such as flip flops / mules / crocs.
Look for a shoe that has the following qualities;
- Heels should be broad and no more than 1.5 inches high.
- Soles should be firm and non-pliable.
- Deep fitting footwear will provide plenty of room for your toes and accommodate any potential toe deformity.
- Lacing or Velcro straps to hold the shoe firmly to the foot. E.g. running or walking shoe
- A rocker at the forefoot can limit bending of the joint during gait and therefore reduce pain
Targeted strengthening and stretching exercises for the muscles in and around your foot and ankle can help to improve your symptoms. Local NHS Ayrshire & Arran podiatrists have devised exercise videos to help with strengthening the correct muscles.
Ice
Icing can be beneficial in the first 2-3 days following injury or to help manage any flare ups of pain. Please click here for more advice on how to ice your foot. Some people do find continual benefit of regularly icing for several weeks following the injury.
Topical creams/gels
Applying anti-inflammatory gel across ankle joint can provide some symptomatic relief in the short term.
Oral pain medication
Non-steroidal anti-inflammatories medication can sometimes be prescribed by your GP. Please click HERE for further information on pain medication.
Weight Management
If you have a higher than average body mass index (BMI) you are more at risk. Please click here for further support with managing weight.
Foot Orthoses
Foot orthoses: may be considered if self-management and exercises have not improved your symptoms. Your local MSK podiatrist may prescribe some foot orthoses to wear in your shoes to try and offload the joint. Relief can be felt from a stiff, firm insole or one which provides a metatarsal support at the painful joint.
Investigations / Surgery
Do I need a scan?
Capsulitis is usually diagnosed primarily via a physical examination and patient history. X-rays and additional imaging tests such as diagnostic ultrasound scans can also be used to confirm capsulitis and evaluate the extent of deformity.
Will I need surgery?
Surgical management is not usually considered unless you have tried all of the above measures and continue to have difficulty walking. If all non-surgical treatment has failed or you have developed a fixed toe deformity then it may be appropriate for a referral to an orthopaedic surgeon to consider a surgical intervention.