surrounding each joint in the body (joint is made up of two connecting bones) you have a ligament to keep the two bones in proximity of each other. These ligaments are known as capsular ligament. When the joint is strained the capsular ligaments are the first to inflame.
Certain activities like wearing high heel shoes, bending and stooping lead to straining the capsular ligaments. Pain is usually in the bottom of the forefoot.
Treatment: Because Capsulitis is caused by mechanical trauma to the forefoot first and foremost is to stop causing trauma to the forefoot. Whatever activity is causing pain should be stopped. Next fat metatarsal pads and metatarsal gel pads will help. Wearing a shoe that takes pressure off of the forefoot might help as well. Certain types of rocker shoes like sketcher rockers, clogs or custom made orthotics might help as well. See our section of custom made orthotics from our office. Physical therapy modalities can help to reduce the pain and inflammation. If you still are able to function due to the pain you should see a Podiatrist for a cortisone injection. In very severe cases surgery may be necessary.
The may occur by entrapment of the nerve which runs to the toes and passes through the metatarsal bones. It often occurs by putting too much strain on the forefoot. This condition may occur from bending down on the forefoot with pressure for long periods of time or doing lots of walking in high heel shoes.
Treatment: Remove the source of the trauma to the foot. This may mean stop whatever exercise produce the pain as well as changing shoes. Physical Therapy may help control the inflammation. A custom orthotic may need to be made to help with any foot abnormalities and to reduce pressure on the metatarsal heads.
A bursa is a fluid filled sac between muscles, tendons, ligaments and bone. The sac acts like a shock absorber to reduce friction from between the soft structures sliding over the boney prominences. These sacs can become inflamed and cause pain. An inflamed sac is call Bursitis. Common locations for Bursitis in the foot are;
Treatment: The activity that is causing the bursa to inflame should be stopped or reduced as much as possible. Physical Therapy may be done to reduce the inflammation of the bursa. Foot massage may also stimulate blood flood and help reduce inflammation. The massage should be done by someone who knows the technique for reducing inflammation or they can cause more inflammation. Custom orthotic may be needed if there are mechanical foot problems.
The first toe is hyper-extended, bent upward and back. It often occurs in athletic injuries and is usually not that serious but is dehabilitating and can hinder performance. Turf toe is the result of the capsular ligaments been stretched. These ligaments inflame and cause pain.
Treatment: Physical therapy to reduce the inflammation and restore joint function should be started as quickly as possible. The activity which caused the injury should be stopped from 4 to 6 weeks. Better shoes should be purchased to reduce the chances of the injury happening again. Custom orthotics may be necessary to help mechanical foot issues. Turf toe may happen to any toe and is not limited to the big toe.
There are two small bones located under the first metatarsal bone. When these bones are stressed they become inflamed. Once these bones are inflamed it is called Sesamoiditis.
Treatment: It is important to rule out sesamoid fracture. An X-Ray should be taken when fracture is suspected. If there is no fracture, physical therapy should begin. Orthotics should be casted if a high arch is suspect.
The plantar fascia ruptures and forms a nodule. This nodule can form scar tissue and enlarge. It can present as a lump in the foot and may eventually cause pain.
Treatment: Hyper fibroblastic activity very often makes this difficult to treat. Ultrasound to break up the fibromatosis may help. In some cases surgical intervention by a Podiatrist is necessary.
Heel Pain, bone spur:
Calcification of the plantar fascia ligament can occur causing heel pain. A spur can form which can trap a nerve causing pain in the heel of the foot.
Treatment: Stretching the Plantar Fascia and physical therapy should be done. If improvement does not take place steroids followed by surgery may be necessary. They should only be used as last resort if therapy fails. Stretching program as well as change of occupational habits should be done immediately. Orthotics may also help for biomechanical issues.