The pain and discomfort that capsulitis can cause beneath the ball of your foot can be maddening. 

It feels like you have a small stone or marble in your shoe – except you might not even be wearing shoes at all! In fact, it often feels worse when walking barefoot on hard surfaces.

Such symptoms, combined with swelling and/or instability around the second, third, or fourth toes, are likely signs of capsulitis. 

Capsulitis is not a condition that improves on its own. The sooner you can begin proper treatment, the more likely you are to fully regain comfort and prevent progression of the problem.

What is Capsulitis?

At the ball of the foot, where your metatarsals connect to your toes, connective tissues form a “capsule” around the bone ends, holding them together to create stable metatarsophalangeal joints.

When these joints are subjected to repetitive stress, pressure, or strain, they can become inflamed, weakened, and unstable. This is capsulitis.

Left untreated, capsulitis will typically worsen. Pain may gradually worsen, and it can become more difficult to wear shoes comfortably. Eventually, the joint can become so unstable that the toe begins to drift out of alignment, rubbing against and even crossing over a neighboring toe.

What Causes Capsulitis?

Overuse or trauma can contribute to capsulitis. This can involve the repetitive impact of running, as well as anything that might cause you to spend a lot of time with your weight forced against your toes (e.g. stooping while weeding, wearing high-heeled shoes, etc.).

Beyond this, however, we must also consider abnormalities in foot structure or gait mechanics. These factors can greatly contribute to your risk of developing capsulitis, and can include, among others:

  • Having a bunion
  • Having a second toe that is longer than the first (aka Morton’s toe)
  • Having a flexible flat foot
  • Having instability of the first metatarsal

While you can often make changes to mitigate external causes of capsulitis, internal causes require more professional attention.

man with pain in ball of foot
Feet of woman doing exercises with stress ball in clinic

Treating and Managing Capsulitis

Initial treatment recommendations for capsulitis are very similar to those involving a bunion. Both typically focus on providing proper support to stabilize the first metatarsal and even the weight-bearing forces beneath the second, third, and fourth metatarsophalangeal joints.

If capsulitis is in its early stages and the affected toe has not yet begun to shift, conservative forms of treatment can often relieve the pain and inflammation, allow the condition to heal, and help prevent recurrence.

Parts of a conservative treatment plan may include:

  • Rest. Staying off the affected foot will provide the connective tissues around the joint better opportunity to heal. We will typically recommend ice and elevation as part of this protocol.
  • Custom Orthotics. Providing exact amounts of cushioning and support to the foot can help shift excess weight and pressure away from the joints.
  • Stretches and Exercises. Specialized routines focused on conditioning connective elements can take further stress off the joints. Depending on the situation, this could include stretches for the feet all the way up to the calf muscles.
  • Splints and other Devices. Splints, braces, or taping may be used to help maintain the toe in its correct alignment, helping to relieve pain and improve stability.
  • Medications. For relief of pain and inflammation.

If the toe has significantly drifted, or conservative measures have failed to provide adequate relief, we might recommend surgical repair of the joint instead. If this is a possibility, we will discuss all your options with you and answer any questions you may have before you decide how to proceed with your care.

Get to the Source of Your Ball of Foot Pain

Whether capsulitis, a neuroma, or another problem is causing you pain and discomfort around your forefoot or toes, do not delay in seeking proper care! 

Call us at (252) 638-4700 to schedule an appointment at our New Bern office. If you prefer to reach us electronically instead, you are welcome to do so by filling out the contact form at the bottom of this