The hard and rigid parts of the human structure seem to get all the attention. Like skulls, rib cages, and spinal columns. But don’t get distracted by them because ligaments are the unsung heroes of our skeletal framework.
Ligaments are strong resilient bands made from a very tough material called collagen. Ligaments attach bones to bones (as differentiated from tendons, which attach muscles to bones). Ligaments make it possible for our skeletal structures to work together as a harmonious whole.
Without ligaments, our skeletons would be nothing more than an unhinged collection of loose bones.
A particularly important category of ligaments is called “capsular”
Since you’re reading this article on the UFAI podiatry blog, you won’t be surprised that we’re concentrating on the ligaments of the foot. We’re particularly focusing here on the capsular ligaments which strap the metatarsals (the five long bones in each foot that extend from the ankle to the base of each toe) to the toe bones
The joints where the metatarsals meet the toe bones (phalanx), are called metatarsophalangeal joints (more conveniently known as MTP joint). Capsular ligaments encase the junction of the metatarsal and the toe bone, while inter-metatarsal ligaments link together the necks of all five metatarsals.
The area of the sole around the MTP joint at the base of the second toe (the one next to the big toe), is commonly known as the ball of your foot.
Capsulitis is an inflamed toe joint condition
As you already suspect from the name, capsular ligaments form capsules that envelop the junction between bones. These capsules hold the joint together and help it to flex properly.
Capsulitis is inflammation of the ligaments that form the capsule that holds each MTP joint together. Although capsulitis can also occur in the third or fourth MTP joints, it most commonly affects the second MTP joint.
Capsulitis is one of several MTP joint ailments collectively called metatarsalgia
The term “metatarsalgia” does not reference any specific condition. Capsulitis, synovitis, bursitis, and Morton’s neuroma are collectively grouped together under the umbrella of metatarsalgia. Each of these conditions causes toe joint pain, often near the second MTP joint.
- Synovitis is inflammation of the synovial membrane that lines the cartilage sheath surrounding an MTP joint. When healthy, the synovial membrane produces an oily liquid that lubricates the joint. Like capsulitis, synovitis usually occurs in the second joint.
- Bursitis is inflammation of a bursa, i.e., one of the small fluid-filled sacs that lie between each of the MTP joints. Bursa are useful. When healthy, they space the joints and enable them to flex uniformly.
- Capsulitis is inflammation of the ligaments that form a capsule around the joint.
What causes capsulitis?
Capsulitis, and the other conditions grouped under the heading of metatarsalgia, are usually the product of repetitive actions that lead to overstress. But they can also be the result of sudden trauma, arthritis, or even gout.
Abnormal foot mechanics, such as a big toe bunion, a second toe that is longer than the big toe, and an arch that is structurally unstable, can also contribute to capsulitis. Inappropriate footwear (like high heels) is another common source of the conditions that cause capsulitis.
What are the symptoms of capsulitis?
The primary signs of each of the MTP joint aliments are ball of foot pain and discomfort. Patients often describe the feeling as continuously walking on a small pebble under the ball of the foot. Swelling, numbness, and tingling often accompany the pain.
The pain increases when high levels of activity overstress the affected MTP joints. Walking barefoot can be especially painful. As the condition progresses, the second toe may gradually reposition itself, so that it drifts over the big toe.
How are the conditions that cause metatarsalgia diagnosed?
Well, it’s not straightforward, because each MTP joint condition mimics the others. The resulting confusion has led to a multitude of names for inflammation in or around an MTP joint. The MTP joint problems known as capsulitis, synovitis, and bursitis are sometimes also called pre-dislocation syndrome, arthrosis, MPJ instability, and lesser metatarsal overload.
Entanglement in the area of an MTP joint, between a nerve and a benign growth called a Morton’s neuroma, can also result in similar symptoms
Let’s not forget the plantar plate
There’s an important component of an MTP capsule called a plantar plate. It’s made of thick cartilage, and it reinforces the base of the capsule. A plantar plate isn’t as subject to inflammation as are the ligaments, bursae, and synovial membrane, but it’s just as vulnerable to both consistent overstress and abrupt trauma.
Plantar plate damage also belongs under the blanket term of metatarsalgia because a tear in a plantar plate can produce symptoms identical to those caused by capsulitis, bursitis, synovitis, and Morton’s neuroma.
That multiplicity of similar conditions, causing identical symptoms in the same small area, vividly illustrates why it is so very important to find an experienced podiatrist for accurate diagnoses and effective treatment of ball of foot pain.
That seasoned expert will use the history that you provide, visual observation, palpation, manipulation, x-rays, and more advanced imaging techniques to precisely determine which of the shape-shifting metatarsalgia conditions bears responsibility for your toe joint pain.
What are the treatment options for metatarsalgia?
Custom orthotics can be beneficial in the treatment of metatarsalgia
Most MTP joint conditions (other than Morton’s neuroma) are caused by repetitive stress, so the natural remedy is prolonged rest. Other conservative treatment includes:
- Stretching exercises.
- Applying ice packs.
- Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, can help relieve pain and inflammation.
- Taping or splinting. If the second toe is drifting toward the big toe, it may be necessary to strap it back where it belongs.
- Shoe modifications are usually prescribed. Wearing shoes with stiff soles can help ease the amount of pressure on the ball of the foot.
- Custom orthotics are often very beneficial.
When is surgery needed for capsulitis?
The best time to treat capsulitis of the second toe is in its early stages. Once the second toe starts drifting over the big toe, your doctor may discuss surgical options with you. Effective surgical cures are available for even the most difficult cases.
Why choose University Foot and Ankle Institute for your toe joint pain?
If you’re experiencing any foot conditions, we’re here to help. Our nationally recognized foot and ankle specialists offer the most advanced podiatric care and the highest success rates in the nation. We are leaders in researching, diagnosing, and treating metatarsalgia.
For more information or to schedule a consultation, please call (877) 736-6001 or make an appointment online now.
Dr. Briskin is a Diplomat of the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons. He also serves as an assistant clinical professor at the UCLA School of Medicine.
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