Capsulitis/Metatarsalgia (What is this?)
This is a symptom of a problem with one of the metatarsal phalangeal joints of the foot usually the 2nd, but can be others or more. The joint will have more pressure on it for a variety of reasons but most commonly from an elongated metatarsal with or without a hammertoe. In many cases a bunion can be present which may or may not be painful but often needs to be addressed as well. This condition must be differentiated from a nerve entrapment or both can be present. The types of shoes you wear often contribute to the pain. Feels like you are walking on a marble and will be deep aching type of pain.
Conservative treatment options
Ice, NSAID’s, Oral Steroids, Injection of steroids, PT, Shockwave therapy, Biologic regenerative injection, Orthotics, Taping/Pads.
this will depend on what deformities are present in the foot when reviewing x-rays. The goal is to remove the forces on the joint. Commonly a shortening osteotomy of the affected bone(s) is carried out and fixated with a screw. In some cases if a bunion is present this will have to be addressed as well because the first ray must be functional to take the load from walking or running. If a hammertoe is present this must also be addressed and this can be done via minimal incision technique (MIS) or standard technique. Also very often one of the main contributors to this problem is a tight heel cord or Achilles. If significant enough, this will need to be lengthened with a small incision in the mid calf area.
Post Op recovery is typically 48 hours of elevation, ice and no weight bearing. Then into a cam boot for 4 weeks followed by graduated weight bearing in a stiff shoe or sneaker. Full activity in 3 months.