Encapsulitis info needed

[Betty]

Hello everyone,
First off, I'm very glad to have found this forum!

I'm writing to ask for any info or advice about encapsulitis. I have been diagnosed with this in my second toe in each foot and received cortisone (I think) injections today, given a 2 week prescription for motrin, as well as was fitted for some shoe implants. The podiatrist said he was trying to avoid surgery, said it was "classic encapsulitis", and commented that the toe was too long in my right foot.

My symptoms I believe started with shoes...I wear good shoes but have wide feet so often feel that my feet are squeezed even in wide, well supported tennis shoes. It started with numbness in the ball of the foot, and now I have that, plus pain in the toe joints, sometimes pain in the whole sole of my feet, rare shooting pains from the top in my 2nd toe joint, and in particular, the first step out of bed in the morning is the hardest; my feet seem very sensitive then but gradually the pain backs off some.

Does this sound like an accurate diagnosis? Any advice or comments?

In addition to my feet problems, I have two knee injuries...have gotten cortisone shots in them 4x this year and have pending surgery, plus broke my rib 3 years ago in the front cartilage area which has never healed correctly. I have arthritis all over my body and have also been diagnosed with mixed connective tissue disease.

This is all depressing because I have been very active in dancing, running, biking, hiking, etc in my past. I'm 49 years old.

Thank you for any info!
Betty

[Dr. D]

There can be many causes of pain under the ball of the foot. Pain under the 2nd MPJ is a common area for pain. This is called second metatarsal overload syndrome and can result in capsulitis.


Capsulitis is inflammation of the structures around the joint capsule. This could occur in any joint, but in the foot it is most common at the metatarsal phalangeal joints (MPJs). The 2nd MPJ is the most commonly affected as it tends to take up the most pressure.


If the second metatarsal is longer than it should be, it will take up more stress and pressure when walking. This causes the tissues around the joint to become irritated and swollen and typically results in painful ambulation.



In many cases, excess stress placed on the 2nd MPJ is a result of faulty foot mechanics. Excess flexibility at the inside of the foot, specifically the first ray, will result in elevation of the first metatarsal and transfer of pressure to the 2nd MPJ. A combination of a tight achilles tendon, which will transfer weight to the forefoot, a long 2nd metatarsal and hypermobility of the foot, can cause pain and swelling at the 2nd MPJ.


Because you have numbness and have experienced pain shooting to your toes, it is possible that there is a neuroma. A neuroma is an inflamed nerve in the foot and the symptoms can be quite similar to capsulitis.

Treatment is two fold. The first step is decreasing the inflammation. The motrin and steroid injection are both anti-inflammatories and icing will help decrease inflammation as well. The second step is identifying the problem and addressing it. This could be certain types of shoes, faulty foot mechanics or a structural problem, like a long 2nd metatarsal. Orthotics to control any abnormal motion, off weight the painful joint and distribute excess pressure are generally recommended (the shoe implants). Rigid shoes which will decrease stress on the ball of the foot are crucial. If the Achilles tendon is tight, calf stretches are recommended.

Conservative treatment is tried for a number of months before considering surgery. See this post for an example of a shortening metatarsal procedure.

[Betty]

Hello Dr. D,
Thank you very much for this informative and helpful post! I appreciate it very much.

The podiatrist did say something about a long metatarsal and possibly having a surgery but after reading what is involved, I hope that the cortisone, anti-inflammatory and shoe inserts can help; 6 weeks of non-weight bearing is a long time! I also have a pending knee surgery which requires about 6 weeks of non-weight bearing recovery on the same leg. I'm going to think positively that I won't need the foot surgery!

Thank you again!!

Also, thanks for creating and maintaining this site; it's great! I just found it a few days ago and have already read some of the blogs and related links about correct shoe fitting, buying socks, etc. I wish I had known all of this years ago but plan to use a lot of the info after I get my inserts when I purchase some new shoes. I'm also encouraging my husband to read the articles; he has arthritis and stands a lot at his job so I think the info may help prevent him from having problems.
Betty