Capsulitis is one of those conditions that occur on the foot that seem to do very well with orthotic therapy. This is a condition where the ligaments that attach the metatarsal bones to the toes become essentially over stretched on the bottom portion of the foot. The ligaments marked in blue are the capsular ligaments that encompass the metatarsal phalangeal joint.
This can occur for any number of reasons. Aside from the obvious causes such as trauma or the result of athletic activity, capsulitis can occur due to many everyday events.
People who wear a lot of "flimsly" shoes such as flip flops, thin soled sandals will be prone to this condition. This is because when the sole of a shoe is very flexible it causes the forefoot to excessively flex in everyday walking and so the ligaments most prevalent on the ball of the foot thus become over stretched.
High heels are another notorious cause of capsulitis. The high pitch of the foot that is created by excessive heel height once again causes excessive strain on the capsular ligament and pain ensues.
The capsular ligament as the name implies encapsulates the entire joint in an effort to maintain the congruity of the joint. Although there can be irritation and inflammation of any part of the capsule, in the foot at least, it is the bottom of the capsular ligament that becomes irritated.
People in professions such as electricians and plummers, who are constantly kneeling down and thus over extending the back foot will also be prone to capsulitis. People who like to garden, as another example, will also experience capsulitis from the position of their forefoot being over extended.
Individuals who walk up and down stairs barefoot and without carpeting are also prone to this as are people who spend a great deal to time climbing up and down ladders.
So as you can see capsulitis can just be a part of every day living. The problem with capsulitis, just like a lot of other foot problems discussed on this site, is that the condition never gets a chance to "rest" as every time a person walks they are essentially re-aggravating their capsulitis, so it continues to hurt.
There arer other issues to consider with this condition. People who have very high arched feet are more prone to capsulitis because of the high pitch of the metatarsal relative to the toes; it automatically creates a natural extension of the toes. Additionally, people who suffer from what is known as rigid hammertoes (hammertoes which are always in the "hammered" position) may also experience capsulitis behnd that particular hammertoe. Lastly, if a person has one metatarsal bone which is excessively longer than the others, this too may create capsulitis.
Wearing a low heeled, stiff soled shoe can be very helpful in capsulitis as well as medical treatment such as cortisone injections or oral anti-inflammatory medication. However, in conditions that do not respond to those treatments, a patient should consider an orthotic.
This is a situation where a regular orthotic alone will have very little effect on the pain from capsulitis. The goal of an orthotic is to reduce the over stretching of the capsular ligament. To accomplish this we must add a metatarsal pad to the orthotic.
Like other forefoot conditions, the metatarsal pad lifts the head of the metatarsal as the foot passes forward on the ground from when the heel hits the ground to the time the heel begins to lift up and force body weight onto the ball of the foot. The metatarsal pad, placed just behind the heads of the metatarsal bones essentially lifts the metatarsal bones upward. By doing so it reduces the stretching of the capsular ligaments as the toes begin to bend upwards as the foot pushes off the ground.
Secondly, when properly placed, the metatarsal pad will also take pressure off of the capsular ligament, also contributing to relief. See picture to the right.
Placement of the metatarsal pad is crucial as well as the thickness of the pad itself. If the pad is placed too far back, then it becomes useless; too far forward (actually on the metatarsal heads) and it can make matters worse.
If the metatarsal pad is too thin it will offer very little help. Too thick and it may prove to be uncomfortable to the patient, feeling like a "lump" under the foot.
In an ideal world a custom prescription orthotic is the way to go for the simple reason the metatarsal pad will always be in the correct position. Capsulitis is one of those conditions where the other components of an orthotic have little to do with relieving this type of pain and the orthotics sole purpose is to maintain proper position of the metatarsal pad.
You can certainly try any number of arch supports sold in stores to try and alleviate your capsulitis pain, but there are a few considerations.
Those devices are sold by shoe size so rarely is the arch support a perfect fit for a given individual, which means if there is a metatarsal pad already built into the device, there is a very good chance it will be in the wrong position.
Then there becomes the issue of the size of the metatarsal pad itself. Since it is a generic pad built for the average foot structure, you have to hope you are the owner of an average foot. So, if you just happen to have either a very high arch or a very low arch, the built in metatarsal pad may do very little for you.
If you were to try an off the shelf medical grade orthotic which is a pre-made device made out of prescription grade materials, you may fare a lot better, particularly if you get one through a podiatrist, or perhaps a store that specializes in orthotics and has someone working there that actually knows what they are doing. In this case a metarsal pad of proper thickness and density can be properly placed by someone who knows what they are doing.
I have never been a big proponent of prescription orthotics in high heels as it seems like a contradiction of logic. You want to alleviate foot pain as a result of high heels? Stop wearing them! Sounds like good advice but I learned years ago that my only goal should be to be a good podiatrist to my female patients; not their fashion advisor. So with that in mind there is one condition where an orthotic and high heel shoe may work together and that is in capsulitis.
In this case a very thin, actually flat orthotic with a metatarsal pad built into it can be very effective in women who insiist on wearing high heels and are suffering from capsulitis. The orthotic portion does not really need to actually support the arch, it is just there so the metatarsal pad is properly placed.ORTHOTIC RATING:
store bought arch support usually not much help because they do not have good metatarsal pads witin them
medical grade off the shelf orthotic can have metatarsal pad added to them and should be helpful with the understanding that the metatarsal pads will have to be replaced
prescription orthotic the metatarsal pad can be customized, is permanent and guaranteed to be placed in the correct position therefore the best choice.