Capsulitis
Capsulitis
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Capsulitis is a term used to describe inflammation of a joint capsule. A joint capsule is a covering that surrounds a joint and consists of a thick outer layer which gives it its strength and a thinner synovial layer which produces the fluid to lubricate the joint. Micro trauma or damage to the joint capsule can result in excess fluid being produced which causes the joint to swell and become painful when weight bearing. Capsulitis commonly affects the joint next to the hallux but can affect any joint within the body.
Patient Signs and Symptoms
Patient Signs and Symptoms
Pain in ball of foot, often out of proportion with clinical presentation
Symptoms are often vague and non-specific
Swelling in area of pain
Increased pain on walking barefoot or when on tip toes
Not always associated with deformity in early stages
Patients often describe ‘grape’ like swelling or feeling like they walking on a stone
Significant Findings
Significant Findings
Tenderness on palpation of plantar aspect of metatarsophalangeal joint
End of range plantarflexion of digit will be painful
Often a hallux valgus deformity alongside
Positive Drawer test
Associated Findings
Associated Findings
Mechanical (shortened 1st ray, disorders of Hallux, inefficient metatarsal parabola)
Inflammatory Arthritis
Osteoarthritis -Local joint Instability
Gout (blood screening required)
Sudden increase in activity
Change in footwear
Imaging
Imaging
Not indicated at initial assessment unless history of trauma or to suspect osteomyelitis, however x-ray has low sensitivity and specificity for detecting acute osteomyelitis.
Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.
Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.
Differential Diagnosis
Differential Diagnosis
Plantar Digital Neuroma
Stress fracture/Fracture
Freiberg’s infraction
Bursitis
Gout (blood screening required)
Rheumatology/inflammatory arthritis (blood screening required)
Heloma durum
Ulceration
First line treatment options
First line treatment options
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