Capsulitis: Is This the Cause of the Pain at the Ball of Your Foot?

Our Managing Director Troy Parsons shares his recent experience!

As a Podiatrist, it’s not uncommon to get asked by friends and family about foot pain – even over dinner! This happened again not too long ago with a friend of mine, Peter, and I thought I’d share this story as I believe his misdiagnosis of Capsulitis could be a fairly common occurrence.

Meet Peter

A few weeks ago at a function, Peter shared with me that he was having issues with his foot. He had longstanding pain beneath the ball of his left foot, and had been told by his doctor to get an x-ray under the suspicion that he had either a Stress Fracture or Osteoarthritis.

On asking him about the pain, he described it as a bruised sensation that is painful on standing and has gradually been getting worse. Peter owns a construction business and so spends a lot of time on his feet in his RM Williams boots. He’s been putting up with the pain until now, especially as his physical activity has been limited lately, but now it’s at the point where it’s impacting his day to day life.

On Examination

My initial thought was that he may have capsulitis at the ball of the foot, which is one of the most common causes of forefoot pain that I see. Capsulitis describes inflammation and damage to a joint capsule at the ball of the foot. I got Peter into the clinic and examined his foot. The ball of the foot at the 2nd and 3rd toes was swollen and painful on touch. I also found he had a limb length discrepancy, with his painful left foot being longer than the right. He had a limited range of motion through his hip, relatively weak gluteal and core strength, and he was tight through his hamstrings. He was pronating significantly, with the left foot being flatter than the right. I also looked at the liners of Peter’s RM’s and saw that there was a large loading and wear pattern beneath the ball of the painful left foot compared to the right.

I then observed him in stance, on walking and then on our Zebris gait analysis treadmill where we use over 7000 sensors to pick up force and pressure data. On stance, I saw that Peter’s centre of gravity was shifted to the left side, which increases the load and pressure through the left foot. Observing Peter walk, as I had thought, showed that instead of there being relatively evenly distributed pressure through the forefoot being guided toward the big toe for propulsion, there was a large spike in force and pressure under the 2nd toe where Peter was experiencing his pain and swelling. The second metatarsal bone on the left foot was longer than it was normally so it was attracting more load and this was happening at every step, which is why Peter was struggling to resolve the pain on his own.

This is fairly typical of the stress/repair relationship where we stress a bone and it repairs itself, but where the stress outweighs the rate of repair then that’s where we get pain, swelling and damage until we remove the stress and allow the body to heal.

Treatment

This confirmed the diagnosis of capsulitis. I then mapped out a plan for Peter which began with exercises to improve the range of motion around the affected area, icing, elevation and rest where possible. I got him in some Orthaheel slip on orthotic sandals to wear around the house to relieve pressure off the damaged area. For his work boots, I used a prescription pair of custom orthoses to minimise his biomechanical abnormalities and to add a metatarsal raise to offload the painful second metatarsal head.

On initial review, just with the exercises, icing and Orthaheel sandals, Peter described at least a 40-50% reduction in pain and discomfort although he did notice the pain would come back in his RM’s during work (before I fitted the orthotics into them).

After getting the orthotics, he got used to them very quickly and at his next review was reporting an 80% reduction in pain and symptoms. I reiterated the exercises, made a small adjustment to the metatarsal raise to make sure it was perfectly placed, and when I got him on the treadmill while wearing the offloading devices I could see the massive change in pressure across his foot – and better yet – he reported he wasn’t getting any pain while wearing the orthotics.

6 weeks later…

6 weeks after seeing first seeing Peter in the clinic, he reported all the pain was gone, except when he runs around his house in bare feet, which isn’t abnormal as it takes 10-12 weeks for soft tissue to completely repair itself. Peter is progressing very well and we look forward to seeing him 100% pain free very soon!

We often see Capsulitis presenting like this and it’s easy to address. In fact, we love treating it because when we diagnose appropriately, map out treatment plan and get patients engaged and accountable in the execution of the treatment plan then we get GREAT results – which is massively satisfying in helping people realise their potential and in seeing them walking out happy and pain-free!

If you have pain at the ball of your feet or any foot pain that isn’t going away – give us a call today! We’d love to help.
07 4638 3022

About the Author

Qualifications

B.Hlth.Sci.(POD)Hons, B.App.Sci.(HMS-Ed), M.A.POD.A, M.Sports Med. A., A.A.P.S.M.

Director / Podiatrist

Throughout high school Troy experienced a multitude of injuries from a wide variety of sports. He tried everything from GP, physio, chiro and magnets with little success. Then one day while getting fitted for school shoes the man serving him commented that he had very poor lower limb alignment and that he should see a podiatrist. So impressed with the result, he researched the profession and the rest as they say is history.

Having been in the industry for 12 years, Troy is particularly interested in biomechanics, alignment issues, sport/lifestyle related injuries and paediatrics. His career highlight was being one of 20 podiatrists nationwide appointed to the medical team at the 2006 Melbourne Commonwealth Games.

Troy is proud to own a successful and growing practice and strongly believes your feet are your independence. They are commonly neglected and the significance of the feet and lower limb is commonly overlooked. He loves helping people get over their injuries, improving their quality of movement and optimizing their performance.

Special interest in running assessments, technique correction, injury prevention and performance enhancement.