DEAR DR. GOTT: I am an active 66-year-old female of average size. I have had very painful soles of my feet for several years, which are more painful after walking. I have been treated by a chiropractor to activate the mechanics of the feet and by a podiatrist for Morton’s neuroma. Now the podiatrist says I have capsulitis. Please explain that and the best route to recovery.
DEAR READER: Capsulitis refers to inflammation of a ligament anywhere in the body where two bones form a joint, such as at the feet, ankles or shoulders. As an aside, when the shoulder is involved the condition is known as a frozen shoulder or adhesive capsulitis, a condition you have likely heard of.
In any event, when the foot is involved, the second toe is most commonly involved – although the third and fourth toes can also be affected. This condition can occur at any age and is also known as pre-dislocation syndrome. Capsular ligaments surround the joint for the purpose of keeping those two bones in proper alignment so the joint can function properly. Those ligaments that surround the joint base form a capsule of sorts, thus the name. When stress is placed on a joint – either from trauma or otherwise – the ligaments “tear”, causing a condition known as capsulitis which can occur when the ball of the foot receives an excessive amount of weight bearing pressure, because of a bunion, an unstable arch, tight calf muscles, from wearing high-heeled shoes, stooping to garden, or during one’s normal course of employment.
When the second toe is involved, symptoms can worsen if the condition remains untreated. A person may experience progressive pain, swelling and will have difficulty finding comfortable shoes to wear. The patient should apply ice, remain off the foot, use non-steroidal anti-inflammatory over-the-counter medication, and might even consider taping the toe into its correct position because as the condition advances, the unstable toe can bend toward the great toe and eventually cross over it to form what is known as a crossover toe.
Diagnosis is made through a specialist pressing on and moving the foot to determine the extent of injury. X-rays or other imaging studies may be necessary for accuracy.
Capsulitis strongly resembles a Morton’s neuroma, a benign tumor of the nerve cells that results in a burning sensation and – you guessed it – swelling inflammation between the bones at the ball of the foot. The individual will experience sharp pain that increases in intensity when walking or when the ball of the foot squeezes together, either manually or through wearing shoes that fit incorrectly.
Treatment for Morton’s neuroma is similar to that of capsulitis in that it includes resting the foot, applying ice packs, wearing better fitting footwear and taking over-the-counter anti-inflammatory medications. Massage will also work to help reduce the pain. Beyond that, you may benefit from an ultrasound-guided steroid injection or surgical removal. Follow your physician’s advice to avoid progression of the disorder. Walking is excellent exercise; however, is is not usually encouraged for those with a neuroma. There may be shoe inserts and other orthotics which may take pressure off the neuroma and allow you to take frequent, shorter walks without so much pain.
Readers who would like related information can order my Health Report “Managing Chronic Pain” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money oder to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
