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Metarsalgia Capsulitis

Posted by Susan on 12/29/04 at 17:56 (166281)

I have a severe case of Capsulitis (as my Podiastrist dx me of having). I ice the area and take Advil which helps but can't do this forever. This has been going on for two years now. I really could use some answers, or help please. Thanks!

Re: Doctors, any comments?

Jody on 12/31/04 at 10:52 (166333)

I'm having a hard time finding info about capsulitis on the 2nd met joints. You guys must have seen a few cases of this, correct?

Re: Doctors, any comments?

BLT on 1/03/05 at 10:37 (166433)

Is that all your Dr had you do after 2 years? What other treatment and or shoes, inserts etc. has he suggested?

Re: Doctors, any comments?

Susan on 1/03/05 at 13:31 (166445)

Podiatrist #1, made me custom orthodics, although she never Dx me with Capsulitis, her Dx was Fasciitis and Neuroms. After numerous attempts (and 1.5 years) of trying different adjustments, I gave up with her.

Podiatrist #2, after doing an ultrasound says there is no Neuromas, but inflamation from capsulitis, which is causing the burning and pain. Bone scan is negative. I believe Pod #2, as the pain seems to come from and around the #2 met joint, not between it.

Several websites says casulitis is fairly common but after doing a search here, I believe it's fairly rare in the foot, esp the metatarsals. Various websites say to simply take it easy and wear a metarsal pad - tried that- not luck.

My only other alternative (as far as I can tell) might be to simply stay off my foot for a couple weeks and see if that works. But that means missing a lot of work.

Re: Doctors, any comments?

BLT on 1/03/05 at 14:25 (166447)

Some other or similar things you may want to look up is synovitis or metatarsalgia. Basically the joint is painful and inflamed. many times this gets called a neuroma and gets pumped with cortisone. You need to avoid going barefoot or socks or slippers in the house and try to buy a good running shoe or orthopedic shoe from someone that will look at and measure your feet.

A softer orthotic, full lenfth and have them grind out a relief under the painful met head. Also wearing a cushipon sock like a Thorlo will help. Make sure they fit you with a wide enough shoe since many times forefoot issues are made worse by incorrect width

Re: Doctors, any comments?

Ed Davis, DPM on 1/08/05 at 22:17 (166754)

Please note that there is an 'Ask the Doctors' board on this site and the docs tend to look there first.

Capsulitis is very common but that just means that the capsule or covering of the joint is inflamed. Which joints are inflamed and why? That is the key to knowing how to treat this for long term releif.

Capsulitis in the second MTP joint that seems to be hard to get rid of often derives from a hypermobile first ray. What that means is that the big toe joint is not bearing its fair share of weight across the ball of your foot. Normally, if one could place a scale (or pressure sensor) under each of the MTP joints of the foot (knuckle joints) one would find that the first MTP joint, the biggest, takes 50% of the weight bearing pressure and the other 50% is divided up among the other 4 joints. If the big toe joint is not doing its job, for a variety of reasons, then weight bearing pressure on the second MTP joint will be excessive. A big toe joint that tends to ride up too much (hypermobile first ray) is a frequent culprit.

The long term fix is biomechanical. The easy and cheap thing to do is to get a metatarsal bar affixed across the bottom of your shoe. That is simply a strip of rubber or leather that basically lets you rock over the affected area. It is important that the bar be in exactly the right spot so see a pedorthist who can determine the position accurately.

Another option is an orthotic which is specifically designed to bring down the big toe joint so that it is bearing its fair share of weight. A generic insert won't do the trick as this involves a special technique for capturing the foot in a particular position and use of specific wedging techniques (posting). Here again, the accuracy of the prescription means the difference between success and failure. For some reason, a percentage of practitioners are not familiar with the technique needed. Basically the big toe must be bent back gently and the big toe joint pushed down as one takes the impression. Then a wedge that is thicker on the outside and tapers to almost nothing as it approaches the big toe joint so that the big toe joint is pushed and held down is effected.

Re: Doctors, any comments?

Susan on 1/09/05 at 01:08 (166763)

Ed thank you very much for your reply. I did actually post on the 'Ask the Doctors' board, but never got a response. I was beginning to think this might be a fairly rare condition. I appreciate your reply.

1-I'm not sure how I got this condition. All I really know is that it started about two years ago. I do exercise a lot, but have been for many many years.

2-I've seen a couple podiatirst. Pod #1 said it was neuromas and fitted me with custom orthodics. After several attemps and adjustments that failed to relieve any pain/burning, I went to another podiatrist recently.

3-Podiatrist #2 says it's capsulitis. He did an ultrasound. He saw inflamation around the 2nd met head (mainly where it hurts). He said he didn't see a neuroma, he said it's capsulitis.

4-I had a bone scan, negative for stress fractures.

5-Custom orthodics don't seem to help, in fact seem to make my foot hurt more, esp with walking. Soaking in cold water and pain relievers seem to help the best, but I can't do this for the rest of my life.

My question, after reading your reply, it seems that orthodics should be helpful, as you indicated that the first met head isn't bearing it's share of the weight. Do you think I should attempt another try at custom orthodics? Is a metatarsal bar different than custom orthodics?

I appreciate your reply. I will post this response on the other message board.

Thank you.

Re: Doctors, any comments?

John H on 1/11/05 at 10:07 (166890)

Susan: Having had this condition for around nine years I think that many if not most of us go through periods where we think we have a condition other than PF and then get off on a tangent and worry about some exotic disease. Clearly keep looking but also keep in mind if it looks like a rabbit, has ears like a rabbit, and runs like a rabbit it very likely is a rabbit.

Re: Metarsalgia Capsulitis

Len S on 5/02/05 at 14:25 (174112)

Your injury sounds exactly like what I've been experiencing for the last 3 months. The ball of my foot (below the 2nd toe) began hurting, to the point that I would limp if walking across a hardwood floor barefoot. The only other thing I experience besides the pain in the ball of my foot, is my 2nd metatarsal gets swollen when I'm on my feet a lot.(I've been running for 15 years, the last 3 years I've typically run 200 miles/month, and do 2 marathons a year). I still haven't resolved this, but here's what I have done:
1) Stopped running.
2) Went to a podiatrist and a orthopaedic foot/ankle specialist;
3) Podiatrist thinks its capsulitis, began gradual/progressive treatment consisting of:
a) Fairly thick (1/4')/soft foam insert to wear in my shoes (full length). He also placed a cotton pad on the insert, in front of the area where the pain is, to redistribute the load when my foot strikes the ground.
b) Advil.
c) Icing (3 times per day - this helps some).
d) I tape my 2nd toe to the big toe (this helps some).
e) Staying off my feet as much as possible helps (but near impossible to do, although I'm still not running).
f) Orthopaedic said it wasn't capsulitis (because I had full range of movement in my 2nd toe). He didn't really give what I got a name, but prescibed orthodics. He said I had a high arch and my toes naturally point up. When my foot strikes the ground, the amount of force/time on the ball of my foot was excessive. He made a mold of my foot (to fit me with orthodics) by bending my big toe upwards, I think similar to what Ed Davis described.

I'll have the orthotics in about 2 more weeks. I'm hopeful they help. I'm still having the pain, trying to manage it with ice and taping, but I'm still not able to run yet. Hopefully with the orthodics, this problem will be corrected.

Have you learned anything new?
Anybody else have advice?

Re: Metarsalgia Capsulitis

Abbey on 6/15/05 at 18:21 (176900)

This is the first place I have heard others talking about the same symptoms that I have experienced. Just over 3 years ago I noticed swelling in the ball of my foot and pain when walking. At the time I had recently changed from running indoors for the winter to the street for spring. The first doctor ruled out a stress fracture though X-ray and told me to stop running and stay off my feet.

For 3 years I would exercise at the gym and occasionally run but it all depended on how my foot felt. My current job requires being on my feet 10 hours a day which caused the pain to be too much. The first orthopedic doctor tried to pawn me off on a rheumatologist but I have no other symptoms of arthritis and my blood work was negative.

The Second Orthopedic doctor prescribed orthotics but after a month there was no change. He also has me in a cast for 6+ weeks with no diagnosis. The swelling is still present and I am worried that it is going to come down to managing the pain.

I am looking for suggestions of questions to ask the doctor. Also, would it be more appropriate for me to be seeing a podiatrist?

Re: Metarsalgia Capsulitis

joan p on 12/08/05 at 15:13 (189273)

This is the first time I've found others suffering from this problem. I'm a hiker and developed metarsalgia capsulitis in the left foot when, having forgotten my hiking boots or sneakers, I hiked 7 miles in burkenstock sandles - a big mistake. My podiatrist has been more helpful than the orthopedist, though both are dismissive, to my dismay. The podiatrist finally suggested having ROCKER SOLES put on my shoes. He says it's the propulsion, not the weight of walking that keeps the foot from healing. Rocker soles keep the toes from bending when we step. I hadn't heard of taping the toes together, but will ask about that, and I'm wondering about the products I've seen under this ailment - whether they work - the special shoes, the ace bandages for the ball of the foot, etc. Has anyone used any products that have helped? Also, my podiatrist told me that the achilles tendon stretch 6 times a day will help, and I've just started that - stretching one foot then the next out behind while leaning the extended arms against a wall.

Re: Metarsalgia Capsulitis

Catho on 7/12/06 at 11:39 (203798)

Hi Everyone

I'm quite late in joining this thread... does anyone read it any more?

I also have this same problem. Just over a year ago I had a bad pair of running shoes with a bump just under the 2nd metatarsal head in the left shoe. I ran in them a few times, hoping the bump would go away, which of course it did not, and ended up with severe pain. I stopped running (have not run for 15 months). First doctor prescribed orthotics with metatarsal pads that support the metatarsal arch. They help a little but not enough. Eventually I stopped walking (most of this winter I just skied - I noticed I never had pain when ski-ing - I think the stiff boot was key). Every time I try walking again, the pain returns. This year I went to the doctor again - x-ray revealed no stress fracture. I'm currently trying physio - but to no avail.

The most helpful thing I have done is to get a sturdy pair of shoes with a stiff sole so that I don't bend my foot as much with each step. I wear them almost all the time (and avoid walking barefoot at all costs as this seems to be the worst thing for me to do). The shoes help but I still cannot walk for more than about 30 minutes without pain returning. I am wondering if I need a completely solid sole that does not bend at all?!! I keep trying to be patient and hoping that eventually things will improve, but reading your threads of ongoing problems for so many years, I am losing hope! I do not particularly miss running but I am an avid hiker, and just recently moved to the mountains, so not being able to get out on adventures is really tough!

Has anyone had any more successful attempts at treatment since the last postings?

Re: Metarsalgia Capsulitis

Regina M on 10/10/07 at 03:30 (237456)

Try MBT walking shoes/ hiking boots, the curved sole really makes a difference for me. I find they are the only things I can walk in without pain/swelling.

Re: Metarsalgia Capsulitis

123456 on 10/13/07 at 02:14 (237640)

I have been in the same condition as everyone I have read about on here and it helps to hear the stories. I have a neuroma and capsulitis in the same foot and the only thing I have found that helps relieve the pain some is Earth shoes as they make you roll back and walk more on the heel and thus not put as much pressure on the ball and toes of the foot.

Re: Metarsalgia Capsulitis

SuzP on 11/17/07 at 15:56 (239564)

I too have been experiencing this sort of pain since January 2007. I have been to 3 Podiatrists and gotten mixed answers.

Pod #1 said most likely capsilitus but may be mortons neuroma
Pod #2 Mortons neuroma
Pod #3 capsulitus

I have had an x-ray and MRI and nothing shows up. I am now getting my second pair to prescription orthodics. This pair is suppose to raise my 2nd metetarsal (where the pain seems to start) and try to give that area a break and to heal.

My pain started out as pins and needle feeling but is now more tingling and sore. It is all in the ball of my foot. My feet seem fine it the morning but as I am on them during the day the pain starts and gradually gets worse. The ony exercise I have been doing is riding a bike since the injury. I was a runner before this. It has been very challenging for me to deal with!!

Has anyone found a successful way to treat this condition? As of now I am thinking it is capsilitus as the 3rd dr. seemed pretty confident that that what is what it is.

Any adivice would be greatly appreciated!!!!!!

Re: Metarsalgia Capsulitis

Lakemom on 11/17/07 at 18:51 (239568)

I too am a member of this group of 2nd met head pain/capsilitis for 5 years now. Depending on what your symptoms I've seen 2 ways to approach the problem. 1. Is provide a relief in your insert/orthotic for the met head to drop into or 2. Provide metatarsal support with either met pad under the second met or met bar either added to the bottom of the shoe or as an insert under the met heads inside your shoe.
There are a variety of materials for met support from cushy poron to red rubber firm depending on what works to reduce your pain. I've tried them all.
3. Merge the above with the right kind of shoe solution either rocker or stiff. Avoid narrow toe boxes or shoes that pitch you onto your met heads.

I used to tape a red rubber met pad under my 2nd met head directly to my foot when I first developed this rather than monkey around finding the exact right place in my shoe or insert. Right now I actually have poron extending under half of my second toe under my orthotics to further support it.

Be patient to experiment. I do those toe yoga exercises which I think really help to strengthen my feet. I cannot get it to go away but just am diligent to not let it get flared up too bad, it is very hard to get it to settle down. Good luck

Re: Metarsalgia Capsulitis

SuzP on 11/19/07 at 13:15 (239621)

Thank you for the response and advice.

Can I ask....what are your symptoms/pain with this condition?
Have you gone to a podiatrist for this? Was your dr. sure of your diagnosis? Did they tell you it would be a life-long condition?

If what you suggested has helped, what do your feet feel like(since you said it has not gone away totally) with using the above inserts?

I appreciate all of the feedback. At this point I am not willing to believe I will have this for the rest of my life so am researching any avenue possible!! Thanks again!

Re: Metarsalgia Capsulitis

SuzP on 12/30/07 at 20:23 (241395)

Has anyone with 2nd metetarsal pain considered or tried Prolotheraphy to try to rid the pain? It is a series of injections that help the area heal?

I have not done it but am researching it as my podiatrist mentioned this as an option.

Any thoughts???

Re: Metarsalgia Capsulitis

Ben on 4/13/08 at 19:39 (245799)

I just ran across this post. I have capsulitis relating to a lisfranc injury several years ago. I have just started getting prolotherapy for the whole foot, essentially, including the plantar fascia. I am just about to pursue prolotherapy for the capsulitis - just curious if you ever got it? I have never heard of anyuone getting this, but I am pretty sure it will help. I also can recommend a particular orthotic if you are interested. I am a physician and spent a considerable amount of time sorting these issues out. If you have had any results from prolotherapy, please email me at shapirob at ucla.edu.

Re: Metarsalgia Capsulitis

Eric F. on 6/10/08 at 14:12 (247546)

Same exact condition - runner - increased milage too quickly, and felt a searing pain in my foot later in the day while walking barefoot on a hardwood floor.

Almost two years later still trying to keep weight off, wider toe boxes, x-rays, gel pads. Now seeing a podiatrist, she thinks it's a neuroma, 3 cortisone shots later, I am still feeling the 'glass shard' when I propel off my left foot.

How can this NOT be healing over this much time? I have had broken bones heal in an 1/8 of the time. If anyone comes accross a successful treatment please alert me. Thank you,

Eric (Beerat at aol.com)

Re: Metarsalgia Capsulitis

Dee on 8/05/08 at 19:50 (248962)

In the post previous to yours, there was mention of rocker soles. I am no doctor, but I do own a pair of MBT shoes, which have rocker soles. Expensive shoes, but they sure do alleviate the pressure on any part of the foot, and distributes it well as you walk. I think I have mild metatarsalgia from dancing flamenco as well as fallen arches. Sturdy shoes with a stiff sole may help you in as much as not bending your foot as much with each step, but I wonder how really comfortable they are, or how your foot or leg is compensating for the stiff sole? I'd give shoes with rocker soles a shot...they are extremely comfortable. They are not recommended for uneven terrain (I'm a hiker as well), but you can likely walk the more flat trails (chips or pavement) in the outdoors as a compromise (avoid tree roots, rocks, uneven ground). Give rocker soles a shot so that at least you can walk for longer periods of time. Good luck.

Re: Metarsalgia Capsulitis

Nicky on 3/06/09 at 01:02 (255659)

I have come upon this board VERY late but I am sure people are still checking three years later. I have had this problem for four months- caused I think by some boots, which, whilst not being very high at all, focused the pressure on the ball of my foot too much.
i have been trying to find out what was wring myself for months- Morton's neuroma? Lisfranc injury? And now I have finally got it...and I know what to do!!!
Thanks guys.

Re: Metarsalgia Capsulitis

Gretchen on 3/19/09 at 06:22 (256076)

I experience similar pain and quite randomly discovered during a deep tissue massage, that massaging the top of the calf muscle, pretty close to the knee joint, relieves the pain. In addition to getting monthly professional massages to keep it loose, I massage the area myself daily.

Re: Metarsalgia Capsulitis

L on 9/28/09 at 22:12 (260912)

I had the same thing (pain in ball of left foot and second toe)caused by very tight toe boxes in my new work shoes. Pod said ice, rest and anti-inflammatories, but the BEST relief was in going to get orthodic insoles. Shane's Foot Comfort Center in Shoreline, WA knew just how to relieve the joint pressure. Lady there stretched my shoes (conditioned them too), and with no sales pressure at all had me try on some BioSole-Gel; self-forming orthodics. When I walked in them I felt instant (but not total- not yet) relief. She then fitted some arch supports too and cut the insoles to fit my foot. Wow. And she explained my injury better than the Pod.
GET ORHOTODIC INSOLES. DON'T WEAR HEELS OR SHOES TIGHT IN THE TOE BOX OR AROUND THE BALL OF THE FOOT. GET GOOD ARCH SUPPORT (the support she gave me isn't exactly in the arch of my foot- seems up higher which alleviated the pressure). Don't know exactly what she did but my feet are much happier.

Re: Doctors, any comments?

MDUBS on 10/05/09 at 17:47 (261081)

I found this site searching for answers to this exact question. I'm over two years now with the same pain in the bottom of my BOTH of my feet. I train in Mixed martail arts and think this is what caused the capsulitis. Here's my timeline
-Went to Internal Medicine, doctor and he said to see a Ortho
-Ortho said its a Neuroma and gave me cortisone injections
-Couple of months passed, went back, another round of cortisone injections
-Now I'm seeing a double certified podiatrist/ortho-podiatrist and he said after more xrays and an ultrasound he said it was capsulitis
-I have taken Diclofenac, Celebrex, used anti-infalmmatory creams, lidocaine patches, and taped my 2nd toe down
-I am picking up my orthotics tomorrow, but honestly I cant imagine that they are going to miraculously take my pain away after all the above did nothing but temporarily relieve the pain (and I'm talking about 30-45 minutes relief)

I am 29 years old, expecting my first child I would like to be able to run after him/her if I have to....What else can I do!?!?