Capsulitis & Metatarsalgia
This is a symptom of a problem with one of the metatarsal-phalangeal joints of the foot usually the 2nd but can be others or more. The joint will have more pressure on it for a variety of reasons but most commonly from an elongated metatarsal with or without a hammer toe. In many cases a bunion can be present which may or may not be painful but often needs to be addressed as well. This condition must be differentiated from a nerve entrapment or both can be present.
Conservative Treatment – this is focused on reducing the inflammation and pain with ice, Rx topical cream, laser and sometimes injections. Strappings can also provide temporary relief and can be done in the office at time of visit. Orthotics also can be effective at removing the load to the affected joint. Sometimes oral steroids can be given for 5 days or so. Shockwave treatment is also another option. In rare cases, a walker boot can be given. Avoid any high heels at all. You must apply ice 4x/day for 15 minutes at a time or it will not help. NO exercise till your pain is gone by at least 90%. Can swim anytime though.
Surgical Options – this will depend on what deformities are present on the foot when reviewing x-rays. The goal is to remove the forces on the joint. Commonly a shortening osteotomy of the affected bone(s) is carried out and fixated with a screw. In some cases, if a bunion is present, this will have to be addressed as well because the first ray must be functional to take the load from walking or running. If a hammertoe is present this must also be addressed and this can be done via minimal incision technique (MIS) or standard technique. Also very often one of the main contributors of this problem is a tight heel cord or Achilles. If significant enough this will need to be lengthened by endoscopic technique. Post Op recovery is typically 48 hours of elevation, ice, and no weight bearing. Then into a cam boot for 4 weeks followed by graduated weight bearing in a stiff shoe or sneaker. Full activity in 3 months.