Capsulitis is most often a result of faulty distribution of weight on the forefoot. Normally when walking, weight is transferred from the heel to the outside of the foot and then we finish with the weight on the inside as we 'toe-off' at the end of each step. During toe-off, most of the weight is carried by the big toe. When standing, the first metatarsal (at the big toe) carries 2/6 of the body weight and each of the others carries 1/6. If increased weight is habitually carried on the lateral (outer) metatarsals, microtrauma in the joint capsule and around the head of that particular metatarsal may lead to injury
Normally, the small muscles that run between the bones of the feet contract during the final phase of each step to prevent the forefoot from splaying (widening) and the toes from curling. If these muscles don't do their job, the forefoot spreads and the toes curl which causes the metatarsal heads to be forced down and they contact the ground harder and this can lead to injury.
As you can probably guess, the onset of capsulitis is usually gradual as microtrauma takes a while to add up into an injury. However, it may arise suddenly if there is trauma to the area or if new shoes are involved. Sudden trauma might include landing hard on the ball of the foot while barefoot or while wearing non-cushioned shoes or stepping on a stone while running.
Pain felt in the area of the ball of the foot, the pain is often a dull ache, much like a bruise. If one bends the toes upwards and applies pressure over the 'knuckles' of the foot, the pain can often be localized to one metatarsal head.
Pain is worse with walking barefoot, especially on hard surfaces like concrete or ceramic tile. Pain often forces a person to walk on the outside of the foot in an effort to avoid stepping on the ball of the foot.
Pain is often reduced by wearing a soft-soled pair of shoes, especially those with forefoot cushioning.
Most cases of capsulitis should respond to conservative care.
First, start with ice on the ball of the foot. This will help decrease the inflammation in the joint. Second, wear soft soled shoes or soft inner sole in your shoes.
If you wear high heels, quit! All that extra force on the ball of your foot could be at the root of the problem.
If this is not effective anti-inflammatory medication or cortisone injections may be necessary.
Functional orthotics may also be used to solve this problem.