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Old 01-25-2004, 12:49 AM   #1
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Question Frustrating toe injury & what is capsulitis?

My podiatrist diagnosed my 2nd toe on the left foot as having capsulitis/neuropraxis. He said that a nerve in the 2nd toe is probably entrapped. I know that capsulitis is inflammation in the joint capsule, right? But that's all I know about it. So what is capsulitis? What are the symptoms? How is a diagnosis made? What is the treatment for it?

It's been over 2 months since I injured my left toes by accidentally banging them into a metal object, and at this point, the main problem is my 2nd toe and the area of the ball of the foot between the first and 2nd toes. I feel tingling and discomfort when that area of the ball of my foot is pressed on. And the underside of the 2nd toe is hypersensitive and it tingles a lot when it is lightly touched. I have to wear sneakers all the time now, but I did find a pair of comfortable shoes by Easy Spirit. I cannot wear any of the shoes that I owned before this injury because they are no longer comfortable.

I am just feeling frustrated that my 2nd toe has not been improving lately, even with physical therapy twice a week. I've already had 2 cortisone injections. The Podiatrist said that he can only give 3 injections in 9 months. I am currently taking Bextra for inflammation.

I am also feeling fearful that I may accidentally bump the bad foot into something and cause more injury. Now I am always careful of how I walk, and I cannot walk as fast or for as long as I used to. If I injure the nerve to this toe again, I don't know what's going to happen to me. Do any of you worry a lot about bumping your bad foot/feet into something and reinjuring it/them?

Thanks for your comments, as I'm going through a really hard time with my toe. I wish I had my life back the way it was before this injury because this problem is limiting my activity.

 
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Old 02-02-2004, 03:41 AM   #2
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Re: Frustrating toe injury & what is capsulitis?

Someone recenlty stepped on my toe really hard when I was in sandals, I am too having this problem. I hope to see my foot doc again this week I will ask some ?s about this. Hope you have found some relief. I know its very distracting pain.
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Old 02-02-2004, 06:36 AM   #3
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Hello Sealover,

I have been diagnosed with capsulitis. After several months of discomfort and pain, my doctor has concluded that I have this problem. I have had three injections. My pain is in the middle toe.I am told that after 3 injections, they start to wear down the tissues on your foot. so try not to get anymore. My problem is so uncomfortable it hurts at all times now. Have you tried orthotics?? I have used orthotics and metatarsal foot cushions to distribute the weight from that area, but i am having no luck. My Dr. has offered me surgery as well, but I am not sure I want this, but the pain is getting worse by the day....

I hope you get relief soon.

I have found you a description of capsulitis below....


Capsulitis is very common in the ball of the foot. Indeed, this is probably the most common cause of metatarsalgia. Unfortunately, it is also one of the most overlooked diagnoses, which is too bad, because if your metatarsalgia is caused from capsulitis, it can usually be resolved fairly quickly.

Symptoms include aching discomfort, but it is frequently experienced as a sharp pain with pressure and with movement of the toe. In other words, if you bend the toe upwards or downwards, you may re-create the painful symptoms, because you're stretching the capsule.

As the capsule surrounds all sides of the joint, pain may develop on either the top or bottom of the foot, or both. But most people find the majority of their discomfort on the bottom of the foot.

Capsulitis is common when the bone in the ball of the foot is plantarflexed or "dropped," meaning relatively lower than the others. It is common, too, when the inflamed metatarsal is excessively long. Trauma, too, whether of a gradual onset or a sudden onset, may create the problem.

The presence of bunions, excessive mobility in adjacent joints and bones, connective tissue disorders, arthritis, (particularly rheumatoid arthritis and osteoarthritis), equinus, sudden trauma, excessive weight, poor shoe choices (especially tight toe box and high heels), repetitive irritation from weight bearing activities, age, gender (females get this condition more, especially if
they've had children), working or exercising on hard surfaces, and a host of other factors are associated with this condition.

When capsulitis involves the great toe joint, it is sometimes known as Turf Toe.

When the damage is severe enough, the capsule may even rupture, usually on the bottom of the foot, destabilizing the entire joint and causing a dislocation of the joint, (discussed below)hammertoes (Contracted Toes).

There are several possible ways to treat the acute symptoms of capsulitis: rest, ice, anti-inflammatory medications, steroid injections, massage, physiotherapy, shoe changes, and padding are just a few. Orthoses designed to redistribute weight away from a prominent bone is likely best for chronic capsulitis.

Surgery to repair ruptured joint capsule, or to lift, shorten, or otherwise alter a prominent bone may be indicated at times.

Last edited by CJBermuda; 02-02-2004 at 06:37 AM.

 
Old 02-02-2004, 11:24 AM   #4
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Re: Frustrating toe injury & what is capsulitis?

Hi CJBermuda,

First, thanks for all of the info on capsulitis. I appreciate it. I'm so sorry to hear that you are suffering from pain in your foot. If I were you, I would leave surgery as your very last option. I have had 2 cortisone injections on the dorsal side of my foot, and I too am afraid of weakening the tendons with cortisone. Did your cortisone injections help with the inflammation? Did the injections help relieve your pain? But obviously, you are currently in a lot of pain, so the injections didn't solve your problem. Have you gone to physical therapy for your foot? Are you taking anti-inflammatory meds?

I just cannot believe how long it takes for foot problems to heal! And sometimes foot problems do not get better. My podiatrist told me that the nerve may be healed by summer (I will celebrate if that happens), but he said it could take up to 4 years to heal. He also said that I may have to have surgery if I'm still bothered by the toe in a year or inject the nerve with alcohol (I don't like the idea of having surgery or of an alcohol injection).

I had previously injured a nerve in that same exact toe 10 years ago (but it only bothered me as I stepped onto the floor getting out of bed in the morning and felt fine for the rest of the day...it only tingled if I tapped with my finger at the base of the toe on the plantar side of the foot). Anyway, that injury all of a sudden seemed to be completely healed this past September...and then, "Bam!", I injure the same toe again as well as the rest of the toes, and this time the injury is much much much worse than 10 years ago.

My podiatrist never brought up the option of orthotics...I am surprised he didn't mention this. I've only been to 2 appointments with him, and said that if the toe was still bothering me in February, to come back for another cortisone injection. That's it! So I'm going to see another podiatrist for a second opinion on Wednesday...he is a podiatrist at a university hospital, so maybe he will come up with something to help my toe.

I hope you also find relief for your foot...there's nothing worse than having painful feet.

 
Old 02-02-2004, 11:40 AM   #5
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Re: Frustrating toe injury & what is capsulitis?

Hello Sealover,

Never heard of "neuropraxis" I am going to search that on the web.

The injections worked for about 1o days,they made my foot very numb and difficult to walk around as normal. After the injection wore off, then the pain was right back. I think each time I get the injection the pain comes back WORSE! Don;t get anymore injections. I do a lot of foot rubbing, icing and try to rest on weekends. IT is hard if you do a lot of walking. I try not to get up from my desk a lot. Maximum of 4-5 fives a day. I am constantly changing shoes and trying to find comfort. TOmorrow I am going to an orthotics specialists, who will make a new pair of orthotics that are really padded around the problem area to help distribute the pain away from the area.

I hope this works as it is my second last resort. AT this time I am really considering surgery once the weather warms up. This is really getting in the way of my normal activity. I am ususally very active with ballet, yoga and pilates. When I do these activities it is usually days of pain afterwards, but lately I have pain without my exercise. As soon as I wake up in the morning my foot aches. I have been taking tylenol pm to get some sleep. I have slippers at work to wear around the office and I keep my feet on a box under my desk, just to try and help eleviate the pain.

Sorry for my rant, but this has been since May 2003 and not getting any better. I am very trusting of the surgeon that will perform the surgery. I just cannot see myself hopping around for a long time and the recovery... I think I will just have to settle myself down and have the surgery and relax for a while.

Have you tried metatarsal pads as well. I bought a few of these from the pharmacy and wear them in my shoes daily. It helps a little but you need something that really gets the spot and has plenty of padding.

Good luck to you and hope you find relief soon.

 
Old 02-02-2004, 05:57 PM   #6
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Re: Frustrating toe injury & what is capsulitis?

Hello,

So my podiatrist today said what i have is a stress fracture in the toe, the one next to the pinky, I have a cast -like thing on it that I have to wear except when using ice. I thought of asking for an anti-imflamatory but I forgot, I used to take Vioxx for my neck, I wonder if that would work. I am worried though about capsultits since it says that its underdiagnoised.
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Old 02-06-2004, 04:51 PM   #7
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Re: Frustrating toe injury & what is capsulitis?

mdla,
I broke my pinky toe when I was 15 years old, and everything healed perfectly. I never had any complications from the injury. The toe was splinted and I had to walk on crutches and I had to take codeine/tylenol for pain...this was one painful toe!! Hope your toe heals soon!

CJBermuda,
I went to a new podiatrist on Wednesday, and he didn't diagnose my toe with capsulitis, but my other podiatrist made that diagnosis. The new podiatrist confirmed that a nerve in my toe is probably compressed, and he also said I may have RSD. Also, my new podiatrist was against me having anymore cortisone shots, stating that they could weaken the tendons/ligaments (which has already happened in my 1st 2 toes) and that he's seen dislocated toes as a result of too many cortisone injections; however, my other podiatrist wants to give me another cortisone shot this month if I'm still having problems. I've decided to stay away from the shots. I have noticed an area of fat pad atrophy in the ball of my foot, and this area falls right underneath where a shot was given, so I wonder if the atrophy is due to a cortisone injection that was injected too deeply; I'm sure my other podiatrist who gave me the shots would deny that this could happen. The new podiatrist didn't suggest metatarsal pads, and he said orthotics wouldn't help the problems. I'm still going to physical therapy 2x per week, and I keep praying every day that my foot will be healed soon. By the way, I met a woman in physical therapy who has capsulitis in both feet. Anyway, I really hope surgery works for you because you've gone for too long with pain...keep the board updated on your progress.

 
Old 02-08-2004, 11:15 AM   #8
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Smile UPDATE: Now starting Iontophoresis treatments

A quick update: My physical therapist gave me my first Iontophoresis treatment on the ball of my left foot & left toe, and I think I'm noticing some improvement over this weekend. I will receive a total of 6 Iontophoresis treatments. According to the Life-Tech website: "Iontophoresis is an effective and painless method of delivering medication to a localized tissue area by applying electrical current to a solution of the medication. <snip> Like electrical charges repel. Therefore, application of a positive current will drive positively charged drug molecules away from the electrode and into the tissues; similarly, a negative current will drive negatively charged ions into the tissues."

I've already had several ultrasound therapy treatments, and those treatments have ended, yet I was still in pain. So I hope Iontophoresis does the trick. I still have a tingling sensation in my 2nd toe on the left foot, but less pain in the ball of my foot below the 1st & 2nd toes. This is the first weekend that I am walking normally in the house without much pain and without limping. I hope this progress continues!!

 
Old 02-09-2004, 05:01 AM   #9
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Re: Frustrating toe injury & what is capsulitis?

Sealover!!

Glad to hear about your new treatment. I hope that this gives you lots of relief!!

Keep us updated on your progress.

Great news!

CJ..

 
Old 02-09-2004, 12:08 PM   #10
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Smile Re: Frustrating toe injury & what is capsulitis?

CJBermuda,

Thank you so much for your well-wishes for me. I also hope that you find relief from your pain very soon!...and please keep the board updated on your progress.

 
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