The Center for Podiatric Care and Sports Medicine

Forefoot Pain? Could Be Capsulitis

Posted by on Tuesday, September 11th, 2012

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I love my forefoot–forefeet, actually, I don’t favor one over the other. No, seriously, I do. Without my forefeet, I wouldn’t be able to stand on my toes, kick a ball, or pet my dog when my hands are busy typing. Actually, I wouldn’t even be able to take a step–without your forefoot, the roll-through from heel to stumpy midfoot wouldn’t be much more than a hop. So let’s hear it for the forefoot. Yay, forefoot!

Of course when something is as important to an everyday activity as a forefoot is to walking, there’s a lot of room for things to go wrong. For example, you can develop capsulitis.

Capsulitis? Wasn’t he one of those third century Roman emperors who ruled for about two weeks before meeting an unfortunate end? No, you’re thinking of–well, I don’t know who you’re thinking of.

Is it something you get from traveling in one of those early space program capsules that were shot into the air? No, though it would be a good name for that disease if it existed.

Okay, explain. First, a small anatomy lesson–the joints in your body are each covered by a capsule, which helps keep them in place and operate smoothly. When the capsule becomes inflamed and irritated, you have capsulitis. You can get capsulitis in any joint in your body, but one of the most common places is in your forefoot at the top of the second metatarsal, at the base of your second toe.

Why would my second toe joint become inflamed? Is it angry about always being second to that show-offy big toe? That must be grating, but no, it’s actually a stress problem. If you put too much pressure on your forefoot, you’ll develop capsulitis. This could come from bad shoes (think towering heels), a too quick shift to forefoot striking in minimalist running shoes, or simply bad biomechanics.

How would I know I have it? Well, forefoot pain in the area of the second toe is the most obvious symptom. However, that could point towards some other conditions as well, so the best way to find out whether you have capsulitis or something else is to see a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900).

Let’s suppose that I have capsulitis. Do I have to worry about it? Or can I just let it chill on its own? You do need to do something about it. If left untreated, the ligaments around the joint can weaken and the toe can become dislocated.

I’d rather not have that happen. What can I do to avoid letting my toe dislocate? Treatment usually starts by reducing pain and inflammation with rest, ice, and over-the-counter pain anti-inflammatories, such as aspirin or ibuprofen. The next step is to try to solve the problem that caused the capsulitis, by taking pressure off the irritated area of the forefoot. Metatarsal pads or cushions help by reducing pressure on one metatarsal by spreading it throughout all the metatarsals. You can usually buy small generic metatarsal pads in drugstores, or a podiatrist can custom fit your feet for orthotics that will target the exact problem area.

If those first two steps don’t help, a cortisone shot can reduce inflammation and pain. Sometimes the relief may prove long-lasting, but often this is just a case of putting a band-aid on a symptom;  it doesn’t really address the problem.

When all else fails, there are surgical procedures for capsulitis. These focus on repositioning or shortening the bones that are contributing to the pressure on the joint. However, as with any foot surgery, recovery can be long–often about three months.

With that in mind, it’s always better to at least try to attack the capsulitis problem early, as soon as you notice pain in your forefoot. We can’t guarantee that will keep you away from surgery, but it will improve your chances!

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.