What is capsulitis?
Capsulitis is the inflammation of ligaments (the joint capsule) surrounding the metatarsal phalangeal joint.
What is metatarsalgia?
Metatarsalgia is a general term used to describe pain and inflammation in the metatarsal region of the foot, more commonly referred to as the ball-of-the-foot. This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads-the rounded ends of the bones that connect to your toe bones, or more isolated at the first metatarsal head near the great toe joint.
What causes capsulitis and metatarsalgia?
Most inflammation occurring around the capsule and metatarsal heads develops when something changes in the way one’s foot normally works (mechanics), affecting how one’s weight is distributed. This can put excess pressure on the metatarsals, leading to inflammation and pain, especially in the metatarsal heads.
Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:
Intense training or activity. Runners are at risk of metatarsalgia, primarily because the front of your foot absorbs significant force when you run. During the push-off phase when one jumps or runs, one’s body weight is transferred to one’s toes and metatarsals. The first and second metatarsal bones take the brunt of this force. This condition commonly occurs when performing high-impact activities especially if one’s shoes are ill-fitting or are worn out.
- Certain foot shapes: A high arch can put extra pressure on the metatarsals. So can having a second toe that's longer than the big toe, which causes more weight than normal to be shifted to the second metatarsal head.
- Bunion: A bunion can weaken one’s great toe, which may have an effect on the way pressure and weight are distributed across one’s foot ultimately putting extra stress on the ball of one’s foot. Bunion surgery may also lead to metatarsalgia if you don't your foot enough time to heal properly.
- Hammertoe: This foot condition can develop when high heels or too-small shoes prevent one’s toes from lying flat. As a result, one toe — usually the second — curls downward because of a bend in the middle toe joint. This contraction depresses the metatarsal heads.
- Excess weight: Because most of one’s bodyweight transfers to one’s forefoot when moving, extra pounds mean more pressure on one’s metatarsals. Losing weight may reduce or eliminate the symptoms of metatarsalgia.
- Fat Pad Atrophy: the gradual thinning and loss of the fat pad in the ball or heel of the foot, which exposes the delicate connective soft tissue to pressure and strain to create inflammation and micro-injury.
- Poorly fitting shoes: High heels, which transfer extra weight to the front of one’s foot, commonly causing metatarsalgia in women. Shoes with a narrow toe box or athletic shoes that lack support and padding also can contribute to metatarsal problems.
- Stress fractures: Small breaks in the metatarsals or toe bones can be painful and change the way one puts weight on his/her foot.
- Morton's neuroma: The inflammation of nerves typically occurring in between the third and fourth metatarsal heads, causes symptoms that are similar to metatarsalgia and can be very painful. Morton's neuroma frequently results from wearing high heels or too-tight shoes that put pressure on one’s toes. It can also develop after high-impact activities such as jogging and aerobics.
What are the treatments and preventative measures for metatarsalgia?
At Gotham Footcare we initially treat our patients with non-surgical treatments to alleviate one’s symptoms of pain and inflammation. Conservative measures usually relieve the pain of metatarsalgia in most cases. Initial treatment first consists of determining the cause of the pain. An x-ray of one’s foot will be taken to determine any abnormal position of one or more metatarsals or to rule out a stress fracture or other foot problem.
If improper fitting footwear is the culprit, the footwear must be changed. Footwear designed with a high, wide toe box and a rocker sole are ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot. Unloading pressure to the ball-of-the-foot can be accomplished with a variety of foot care products including Orthotics designed to relieve ball-of-foot pain usually featuring a metatarsal pad.
At Gotham Footcare we use cutting-edge technology to construct our custom orthotic devices. Our orthotics are constructed by laser scanning one’s feet to fabricate a custom device with padding placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Rigid arch supports are made of a firm material such as plastic or carbon fiber. They're designed to control motion in two major foot joints below your ankles. Semi-rigid arch supports are made of softer materials such as leather and cork reinforced by silicone. Arch supports designed to treat metatarsalgia, may also include metatarsal pads to offload pressure to the affected area.
Other products we recommend include gel metatarsal cushions and metatarsal bandages. Resting, icing, use of oral anti-inflammatories, topical anti-inflammatories, and cortisone injections may also be recommended.
If conservative treatments fail, in rare cases surgery to realign the metatarsal bones may be an option. If you're considering foot surgery, we will discuss with you the risks, benefits, and expected outcomes of surgery.
