Capsulitis is inflammation of the capsule of a joint. The capsule is the fluid filled outer covering that joins two bones to make a joint. One of the most common capsules to get inflamed is the capsule of the metatarsophalangeal joints in the ball of the foot. There are five of these joints, joining the metatarsals to the toe bones (phalanges). The most common of these capsules to get inflamed is the capsule joining the second metatarsal to the second toe bones.

People that get capsulitis may report pain, swelling, redness and the sensation of walking on a stone. If it becomes a chronic situation, the individual will develop painful calluses that seem to have a core or seed in them. These are often misdiagnosed as verruca when they actually represent a biomechanical mal-alignment of the foot that results in concentrated weight bearing under a focal boney prominence, in most cases, under the second metatarsal head. These calluses can occur under any of the metatarsal heads and often respond well to orthotics with metatarsal pads and cutouts, which are an orthotic technique that allows the more prominent metatarsal head to drop, lower than its corresponding metatarsals, thus balancing the weight bearing load and decreasing the pressure.

Capsulitis may be difficult to diagnose because of the other related structures in the forefoot that can also become inflamed from biomechanical problems. Sometimes people have nerve symptom (see forefoot pain) associated with the swelling that occurs with capsulitis because the swollen capsule can put pressure on the adjacent nerves. There also are numerous fluid filled tissue sacs in the forefoot called BURSAE. When one of these bursae becomes inflamed, we call it BURSITIS. We generally assume the symptoms associated with bursitis have to do with over-swelling of the fluid filled sac and inflammation of the surrounding tissues.

This capsule generally gets inflamed because the forefoot is out of balance in the way that it is bearing weight, and too much pressure is placed on this joint. Shoes are the most common cause of this by the elevated toe boxes that are on most shoes. The elevation of the toe box increases the pressure under the capsules of the metatarsals. Since the second metatarsal is generally the longest in most feet, it gets more than its share of the weight bearing responsibilities and it becomes inflamed and painful. The tapering of the toe boxes of most shoes on the market also forces the big toe against the smaller second toe and out of balance with its corresponding metatarsal bone.

People with flexible or over-pronating feet often get capsulitis because the more the foot flattens and goes to the inside, the less well the first metatarsal can aid in helping the rest of the metatarsals. Unfortunately, the first metatarsal in this instance is often elevated and too flexible to be effective at bearing its share of the weight. Incidentally, the same scenario that creates the capsulitis we are discussing creates a BUNION, because in addition to the first metatarsal elevating, it also moves to the inside of the foot (adduction) more than it should.

Capsulitis –