Capsulitis of the foot: a guide for patients

What is capsulitis of the Foot?

A capsule is a thick tissue that surrounds joints and provides stability. Capsulitis is joint capsule inflammation, commonly affecting the second toe within the foot. It can also occur in the joints of the third or fourth toes. Left untreated, it can weaken surrounding ligaments and lead to toe dislocation. This condition can affect anyone of any age.

Early stages

• Pain: usually at the base of the affected toe (feels like a smooth pebble or a bunched-up sock in the shoe)
• Stiffness and difficulty moving the toe
• Swelling in the ball of the foot or at the base of the toe
• Difficulty with wearing shoes
• Increased pain when walking barefoot.

Advanced stages

• The unstable toe becomes deformed, separating and crossing over toes.

What causes capsulitis?

It is generally considered that capsulitis of the foot can be caused by:

• Trauma: injury to the foot, such as stubbing your toe or dropping something heavy on your foot
• Overuse: activities that put repeated pressure on the balls of your foot, such as running, jumping, or walking long distances
• Weight: people with a higher than average BMI are more at risk
• Improper shoes: ill-fitting shoes that do not fit well or have good support can contribute to capsulitis, such as high heels, overly flexible soles and narrow shoes
• Abnormal foot structure: people with specific foot shapes are more prone to capsulitis
• Medical conditions like arthritis and diabetes can lead to foot shape changes.

How is capsulitis diagnosed?

Diagnoses are typically made by a clinical examination of the foot. The stability of the toe is tested, and potential causes are established.

X-rays or other diagnostic imaging studies may be requested to assist in the diagnosis, and blood tests may be required to rule out other underlying medical causes.

What are the non-surgical treatment options for capsulitis?

• Rest the area - avoid activities that hurt your foot, and do gentle exercises that don’t strain your feet, like swimming
• Ice - apply ice packs to reduce swelling and pain
• Oral medication -take pain relievers like ibuprofen
• Taping and splinting -taping the toe can help stabilise and offload the joint
• Stretching and exercises help with movement and strength in the foot
• Footwear modifications - wear a wide-fitting toe box with excellent supportive soles
• Orthotic/insole therapy – use custom insoles to support the foot and relieve pressure
• Injection therapy – in some cases, a steroid injection can help relieve pain.

Surgery

Surgery is only considered if other treatments do not work and the pain persists. More advanced stages of capsulitis surgery may be indicated to re-establish the correct toe alignment and restore function.