Capsulitis is a condition characterized by inflammation of a joint capsule, the fibrous tissue that surrounds and stabilizes a joint. While it can affect various joints throughout the body, it commonly impacts the metatarsophalangeal (MTP) joints in the foot, particularly the joint at the base of the second toe. This inflammation can lead to discomfort, often described as feeling like a pebble or bunched-up sock in the shoe. Another well-known form of capsulitis is adhesive capsulitis, commonly known as frozen shoulder, which causes pain and stiffness in the shoulder joint.
Immediate Home Care
The RICE protocol (Rest, Ice, Compression, and Elevation) is a foundational home approach for acute capsulitis symptoms, aiming to reduce pain and inflammation. Rest involves minimizing weight-bearing activities or movements that aggravate the joint, allowing inflamed tissues to heal. Applying ice for 15-20 minutes, several times daily, can decrease swelling and pain. Compression, through taping or splinting, stabilizes the joint and prevents further irritation, particularly in the foot to maintain toe alignment. Elevating the affected limb above heart level reduces swelling by promoting fluid drainage.
Over-the-counter NSAIDs like ibuprofen or naproxen can manage pain and reduce inflammation. Modifying footwear is also important; choosing shoes with a wide toe box, stiff soles, and low heels alleviates pressure on the affected joint. Avoiding high heels and flip-flops, which exacerbate forefoot stress, is important for symptom relief.
Medical Treatments Without Surgery
When home care is insufficient, medical treatments offer further management options. Physical therapy improves joint mechanics and strengthens supporting muscles. A physical therapist may prescribe exercises to improve flexibility and range of motion, addressing muscle imbalances or gait abnormalities that contribute to joint stress.
Custom orthotics or shoe inserts redistribute pressure away from the affected joint and provide support. These inserts correct biomechanical issues that contribute to the condition, reducing irritation.
Corticosteroid injections directly into the joint provide localized pain relief and reduce inflammation. While injections offer temporary relief, they are not a long-term solution and have limited applications due to potential side effects. Repeated injections might weaken surrounding tissues. Other prescription medications may also manage inflammation.
Surgical Options
Surgery for capsulitis is a last resort, considered when conservative treatments fail to alleviate severe, persistent symptoms or when the condition causes structural damage or deformity. In the foot, this might involve capsulitis leading to the second toe drifting towards or crossing over the big toe (crossover toe). Surgery aims to restore joint alignment and function.
Surgery goals include realigning the joint, repairing the joint capsule, and addressing underlying structural issues. For instance, if an elongated metatarsal bone contributes to foot capsulitis, a bone-shortening procedure (osteotomy) may relieve joint pressure. For shoulder adhesive capsulitis, surgical methods include manipulation under anesthesia to stretch the stiffened capsule, or arthroscopy to cut tight portions. Recovery involves a structured rehabilitation program to regain motion and strength.
Post-Treatment Recovery and Prevention
After treatment, whether conservative or surgical, a structured recovery plan is important for regaining function and preventing capsulitis recurrence. Ongoing rehabilitation exercises, often guided by a physical therapist, are important. These exercises strengthen surrounding muscles, improve flexibility, and restore full range of motion.
Gradual return to activity is advised, avoiding sudden increases in intensity or duration that could re-aggravate the joint. Continued use of supportive footwear and custom orthotics or inserts remains important for long-term pressure distribution and joint support. These measures correct biomechanical issues that contributed to capsulitis.
Lifestyle modifications, such as maintaining a healthy weight and engaging in regular, low-impact exercise, reduce stress on joints and support overall foot health. Recognizing early warning signs, such as mild pain or stiffness, allows for prompt intervention and prevents the condition from worsening. Adherence to a long-term management plan helps reduce the likelihood of future episodes.