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Capsulitis in Runners diagnosis and treatment

In our practice pain underneath the 2nd toe joint is one of the most common complaints that we see of patients. Typically this pain presents acutely as tenderness and swelling on the bottom of the foot below the 2nd toe. This is commonly mistaken for a neuroma (nerve irritation). We cannot stress enough the importance of the correct diagnosis of this common foot condition (Sub 2 Capsulitis). The base of the 2nd toe and 2nd metatarsal are attached by a fibrous capsule. Increased repetitive forces (runners), reduction of fat pad on the ball of the foot (increasing age), foot injury, and biomechnical deformities (hammer toe or bunion) of the foot can lead to an inflammation of this capsule. If not diagnosed and treated promptly can lead to a partial or complete tear of this capsule.

Our practice sees a tremendous amount of athletes especially runners. The repetitive forces from running can potentially lead to this condition (Sub 2 Capsulitis). Treatment is geared towards reducing inflammation and offloading the pinpoint area of pain in order to allow the capsular structures to heal. We do not recommend cortisone injections because this potentially could lead to a capsular tear that is why it is so important to get the correct diagnosis initially. Custom orthotics with modifications to take pressure (offload) the bottom of the foot where the pain is located is the first step for long lasting results. NSAIDS, ice, tapings, physical therapy, modification of exercise routine,  topical NSAIDS, and somtimes for chronic cases a brief period of immobilization with a cam walker boot.

A majority of our patients especially runners respond quickly to aggressive conservative treatment and are back to running within three to four weeks once treatment has been initiated. If you are having any pain on the ball of the foot or anywhere else in your feet this is not normal and you should try to get evaluated as soon as possible to prevent a chronic foot condition. If left untreated Capsulitis can lead to a potential tear. When a tear is present surgery is often indicated to repair the capsular tear.

We have at both our West Ashley and Mt. Pleasant offices digital x-ray, diagnostic Ultrasound, and experienced foot specialists that have a passion for runners as well as the recreational athletes. Please contact us if you are experiencing any foot pain.

We hope your training is going well for the Cooper River Bridge Run. We look forward to blogging more about various foot ailments especially relating to our running population.