Causes of Pain in the Ball of Foot
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Capsulitis is an inflammatory condition of the capsule of the second metatarsal where the joint becomes inflamed and painful. It is not exclusive to the second metatarsal joint, occurring in the 3-5th metatarsophalangeal joints, but this is much less common. Symptoms include pain, swelling and irritation exacerbated by walking barefoot on hard surfaces, walking on uneven surfaces or impacting activities such as running or jumping. As capsulitis is primarily an inflammatory condition, if you manage it quickly and correctly, it is possible to cure capsulitis.
Anti-inflammatories such as Ibuprofen can reduce the levels of irritation and inflammation in the capsule but are harsh on your stomach and often used alongside omeprazole.
Gel anti-inflammatories for capsulitis, such as Voltron, are effective localised treatments. Still, it is crucial not to cover the surface for 45 minutes after application; this includes socks or bed sheets.
Impact activity is one of the primary causes of capsulitis, including walking. Still, someone with a flat foot deformity or dropped metatarsal heads can apply pressure on their capsulitis just by standing. As a result, you should reduce the amount of time you spend standing, walking or running.
Think about cycling or taking public transport from A to B; long walks are not recommended.
Cardiovascular exercise has too many benefits to cease when you have Capsulitis. Swimming is the best option to maintain your fitness as there is no direct pressure on the forefoot, and it is doubtful to irritate your Capsulitis.
Cycling with low resistance and high cadence on an exercise bike is a good option, or using an arm bike.
If you like strength training, use machine weights or seated weights only.
A Physical assessment and gait analysis by a Physical Therapist can identify poor mechanics and weakness that may be causing you to overload your capsulitis, worsening your pain.
Addressing these faults with a thorough rehabilitation protocol from a foot specialist can improve your symptoms and reduce the risk of your symptoms returning.
Stable cushioned trainers can help protect your forefoot and reduce the symptoms of Capsulitis by absorbing the shock of impact when walking, and the trainer’s stability helps improve foot mechanics.
If you have highly irritable symptoms of Capsulitis, we recommend wearing cushioned shoes at all times.
Custom insoles are a highly effective treatment for capsulitis as they improve your foot moves with support customised to your needs. There is usually a second metatarsal cut out to take pressure away from the 2nd metatarsal.
Taping is an alternative treatment method that your Physical Therapist might try to limit the range of motion at your second toe so it does not overextend when walking. Taping can be highly effective but a short-term solution compared to insoles.
In severe cases of Capsulitis, a Sports Medicine Doctor may consider an ultrasound-guided corticosteroid injection into the capsule to reduce inflammation levels and pain.
This is usually followed by a period of 1-2 weeks in a walker boot to allow the steroid injection to take maximum effect before recommencing Physical Therapy.
This is not medical advice and we recommend a consultation with a medical professional such as James McCormack before trying any of these exercises. James offers Online Physiotherapy Appointments for £45.