Connective Tissue Injuries

Topics Discussed:

  • Ligament Damage

  • Sprains

  • Capsulitis

  • Synovitis

  • Tenosynovitis

  • Tendonitis (Tendinosis)



A sprain is a soft tissue injury.  It is typically caused by excessive stretch to the soft tissue.  For example, if you twist your ankle, the soft tissue that hold the ankle bones together gets stretched, and you would call it a sprain.  

Below we'll discuss some of the soft tissues that may become strained.  


Ligament Damage

Each joint consists of two bones, with soft tissues holding them together.  There are various types of soft tissues that help hold bones together--including fascia, tendons, periosteum, and capsule, but ligaments--short, cord-like structures are most directly responsible for this duty. 

Ligament injuries are quite common when you twist your ankle, but they may occur virtually anywhere.  Symptoms can range from aching discomfort to deviated or misaligned toes.  

Conservative measures like rest, ice, immobilization, and anti-inflammatory medications may help, but when instability is chronic or severe, the ligaments may be repaired surgically.    




The soft tissue covering that extends like a sheet around a joint is termed capsule.  It's the same kind of white connective tissue you'd see if you've ever pulled apart a turkey or chicken leg.  Adding the suffix -itis to the end of a word means inflammation, so it follows that capsulitis means an inflammation of the joint covering. 

Capsulitis injuries are 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.  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 most common when the bone in the ball of the foot is plantarflexed or "dropped," meaning relatively lower than the others, elongated, or if it is somehow irritated with activity.  Gait abnormalities and poor shoes contribute to this.

When the damage is severe enough, the capsule may even rupture, usually on the bottom of the foot, destabilizing the entire joint.  Indeed, such a rupture can be a cause of a hammertoe

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. 



Synovitis is a condition of inflammation of the joint fluid known as synovium.  Yes, the fluid inside the joint can get inflamed just like the surrounding tissues. 

As the synovium is produced by the joint capsule, this condition may be closely associated with the condition of capsulitis described above.  But trauma, infection, certain types of arthritis and other problems can, at times, inflame the synovium directly. 

If associated with capsulitis, synovitis may be treated in similar ways as describe above.  But if a result of infection, arthritis or other causes, synovitis may need very different treatment than would capsulitis.  Such treatment may even include antibiotics and surgical repair.  


There are a lot more tendons in your body than you may think.  Consider just the toe, for an example.  In most cases, there are two tendons to pull the toe up, two tendons to pull the toe down, not to mention the dorsal interosseous muscles and tendons, the plantar interosseous muscles and tendons and lumbricale tendons, primarily to stabilize the toe and help make the pull of the major tendons more efficient.  

With so many tendons attaching into one relatively-small structure like the toe, it may seem rather surprising these structures don't get injured more than they do.  But tendons are strong and not easily injured.

Symptoms of tendinitis include pain with pressure, joint motion (particularly against resistance), and if chronic enough, misaligned toes may develop.   

Because tendons don't have great circulation, however, when they do get injured, they can be slow to heal. 

Conservative treatment includes rest, ice, immobilization, physiotherapy, and massage.  Surgical intervention is rare, unless the tendon has become ruptured, or degenerative, (a condition called tendinosis), in which case, it is better to fix the problem earlier rather than later. 

This website has a web page that covers tendinitis in greater detail.



Tenosynovitis is an inflammation of the fluid that keeps the tendons lubricated inside their sheath.  If allowed to progress, this condition may cause erosion or scarring of the tendon itself. 

Symptoms of tenosynovitis would be similar to tendinitis--pain with moving the foot--only more severe.

Conservative measures--rest, ice, anti-inflammatories, physiotherapy, e.g.--may all be useful, though surgery is often necessary in severe cases where the tendon has degenerated.  




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This website is operated by 
The Achilles Foot Health Centre
S. A. Schumacher, D.P.M., F.A.C.F.A.S., F.A.C.F.A.O.M.  
Dr. S. A. Schumacher, Podiatric Corporation  

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