Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Capsulitis?

Posted by Kathryn B. on 12/09/02 at 17:31 (102411)

In May of this year, after a very emotionally stressful week, I began experiencing foot cramping. On two previous occasions, I had developed foot cramps while doing lunges at a gym and had gotten massages that helped. (I am on my feet a lot at work). In May, the foot cramping lasted for about two weeks and I developed bilateral metatarsalgia. I went to my primary care physician, who prescribed Vioxx and Xanax. When this did not help the pain (the Xanax did stop the cramping), he referred me to a podiatrist. This podiatrist diagnosed Morton's neuromas bilaterally based upon the click test (although he seemed less sure of the left foot and mentioned capsulitis). This podiatrist does not do surgery or sclerosing injections. I had read about the injections and was interested, so I got a referral to a second podiatrist who does them. He first tried cortisone, though, and I had a bad reaction to this. I was hobbling a few weeks (although I felt numbness the first few hours which was wonderful). This podiatrist says that he feels I have capsulitis and that the click was evoked simply because I have very delicate and close bones. He has ordered orthodics. He said that he would not want to do sclerosing with alcohol since I had the reaction to the cortisone. He said that this might heal with time and rest. I have always worn good shoes, almost never high heels, and my family doctor had just commented a few months before all of this about how good my feet looked. Now that it has gotten colder, my feet feel awful. I have cut back on some of the walking in my job but I am trying to decide if I need to switch to a sedentary job (Fortunately, I can do so in my office, but I dearly love the job I have). So, I guess what I want to ask is does this background seem consistent with capsulitis or do I need to do more to check out for possible neuroma? Would sclerosing help the capsulitis and would it be dangerous after a cortisone reaction? I have been told it could help and be safe, but I am chicken. Does capsulitis heal well or is it likely to be a continuing problem? I am so tired of hurting, and I really need to have some idea whether I am going to need to change jobs or not. I would greatly appreciate any advice. Thanks for such a great webpage!

Re: Capsulitis?

Dr. Z on 12/10/02 at 19:04 (102627)

I would stop the steriod injections at this point. If there is burning and or signs of neuroma, which can be confirmed with ultrasound.I would go for the alchol injections. The diagnosis should be fairly simple. Must rule out stress fracture.

Re: Capsulitis?

Kathryn B. on 12/10/02 at 20:48 (102640)

Thank you Dr. Z!!! Yes, I don't want more cortisone! My primary care physician wants me to go to an orthopedic foot specialist since the two podiatrists disagreed. I prefer podiatrists myself, but this woman is highly regarded in my area, and it might be the best way to get a scan. If there is a neuroma, I will try the sclerosing injections. My podiatrist wasn't wild about the idea because the cortisone went badly, but, to me, I see them as two different substances. I hope he will do them, not many here do. My x-rays are fine, but I gather that stress fractures don't always show up on ordinary x-rays. I really hadn't been doing much that would have caused them unless it would be cramping with some weakened bones. Would you mind telling me anything about capsulitis, in case that is the actual diagnosis? Does it tend to clear up? I have pain on walking on concrete (with light carpet), but I wouldn't call it burning pain anymore. It burned only when the cramping was severe. It is more just soreness and runs across the top of my feet, as well. I can stand a pretty hard massage for it to be a neuroma, I think, but maybe I am wrong. My massage therapist mentions that my muscles are looser each time and he describes a granular feeling in the areas that he finds are painful. I am really not even sure that this is not more muscular in nature. Sometimes such stress has gone to my back, like it seems to have gone to my feet. In those cases, I am not sure that I would have gotten better had I had to pound my back all the time like I have to pound my feet. Just one last question, though. If it is found to be capsulitis, is sclerosing good for that? Dr. Zapf in CA suggested the idea, and he seems super, but how would I then judge if I were still overusing my feet if I did not have pain to tell me? From what I read, that seems like more of a problem for capsulitis than a neuroma once the nerve is deadened, as apparently capsulitis can result in a capsule tear. Anyway, thank you so much!!!! I am a chicken about sclerosing but much more of a chicken about surgery!

Re: Capsulitis?

Dr. Z on 12/10/02 at 21:32 (102644)

If the doctor isn't sure he can order a high resolution MRI or perform a diagnostic ultrasound. The clincial picture with a good examination should do the trick with the diagnosis.

Re: Capsulitis?

Kathryn B. on 12/11/02 at 15:28 (102736)

Thank you, again! The last podiatrist I went to said that it would be hard to get a scan that would likely show anything, but my primary care physician has made another referral and wants one. I sure do!

Re: Capsulitis?

Dr. Z on 12/10/02 at 19:04 (102627)

I would stop the steriod injections at this point. If there is burning and or signs of neuroma, which can be confirmed with ultrasound.I would go for the alchol injections. The diagnosis should be fairly simple. Must rule out stress fracture.

Re: Capsulitis?

Kathryn B. on 12/10/02 at 20:48 (102640)

Thank you Dr. Z!!! Yes, I don't want more cortisone! My primary care physician wants me to go to an orthopedic foot specialist since the two podiatrists disagreed. I prefer podiatrists myself, but this woman is highly regarded in my area, and it might be the best way to get a scan. If there is a neuroma, I will try the sclerosing injections. My podiatrist wasn't wild about the idea because the cortisone went badly, but, to me, I see them as two different substances. I hope he will do them, not many here do. My x-rays are fine, but I gather that stress fractures don't always show up on ordinary x-rays. I really hadn't been doing much that would have caused them unless it would be cramping with some weakened bones. Would you mind telling me anything about capsulitis, in case that is the actual diagnosis? Does it tend to clear up? I have pain on walking on concrete (with light carpet), but I wouldn't call it burning pain anymore. It burned only when the cramping was severe. It is more just soreness and runs across the top of my feet, as well. I can stand a pretty hard massage for it to be a neuroma, I think, but maybe I am wrong. My massage therapist mentions that my muscles are looser each time and he describes a granular feeling in the areas that he finds are painful. I am really not even sure that this is not more muscular in nature. Sometimes such stress has gone to my back, like it seems to have gone to my feet. In those cases, I am not sure that I would have gotten better had I had to pound my back all the time like I have to pound my feet. Just one last question, though. If it is found to be capsulitis, is sclerosing good for that? Dr. Zapf in CA suggested the idea, and he seems super, but how would I then judge if I were still overusing my feet if I did not have pain to tell me? From what I read, that seems like more of a problem for capsulitis than a neuroma once the nerve is deadened, as apparently capsulitis can result in a capsule tear. Anyway, thank you so much!!!! I am a chicken about sclerosing but much more of a chicken about surgery!

Re: Capsulitis?

Dr. Z on 12/10/02 at 21:32 (102644)

If the doctor isn't sure he can order a high resolution MRI or perform a diagnostic ultrasound. The clincial picture with a good examination should do the trick with the diagnosis.

Re: Capsulitis?

Kathryn B. on 12/11/02 at 15:28 (102736)

Thank you, again! The last podiatrist I went to said that it would be hard to get a scan that would likely show anything, but my primary care physician has made another referral and wants one. I sure do!