The joints in the body are held in place by a covering called the capsule. In some cases, this capsule can become inflamed, leading to capsulitis. When this happens in the foot it can cause severe pain in the foot (also known as metatarsalgia). Capsulitis of the foot typically afflicts the ball of the foot as well as the base of the second and third toes. Capuslitis is typically caused by physical stress being placed on the foot joints, which can be a result of deformities within the foot itself or from "overloading" the joints. Joints can become overloaded when too much weight is put on them, which can occur from overuse or from inappropriate footwear (such as high heels).
Most podiatrists and orthopedic surgeons will recommend conservative (non-invasive) treatment as a starting point for patients with foot capsulitis. These treatments work to decrease the swelling and the stress on the affected joints. Capsulitis of the foot can be relieved by applying ice to the affected joints and by taking NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen). Other treatments involve wearing well-fitting shoes and avoiding high heels. Some patients also get relief by wearing cushioning insoles (to help deflect stress) or from wearing special metatarsal pads (which also help cushion and stabilize the joints).
For patients who don't respond to these conservative treatments, doctors may elect to inject cortisone into the joints. Cortisone is a powerful immunosupressant, so it will reduce the inflammation and swelling in the joint. If this measure is not effective, your doctor may elect to try to fix your problem surgically. Because capsulitis can be caused by abnormalities of the bones in the feet, orthopedic surgery may be able to correct these deformities. This type of surgery may involve repositioning or shortening bones to take stress off of the affected joints. Because of the risks of surgery, however, this type of treatment should only be used if you are not responding to other treatments.