Intermetatarsal Bursitis

Summary

  • There are four intermetatarsal bursae. These are located between the interosseous tendons of the foot above the deep transverse metatarsal ligament.
  • Wearing shoes that are too tight or narrow can cause swelling of these bursae.
  • A direct blow to the bursa can produce inflammation and irritation.
  • Causes include constant pressure on the bursa from use of the foot or tight footwear, repeated stress injury to the bursa from a high level of activity, complications from arthritis (rheumatoid arthritis, osteoarthritis or gout) and infection.
  • Bursa can become swollen as a response to other foot conditions.

Diagnostic tips

  1. Pain and tenderness over the location of the bursa. (lateral squeeze test may reproduce pain)
  2. Swelling over the location of bursa.
  3. Loss of motion of the foot.
  4. Pain with activities like walking, jumping, running.

Tests and Imaging

  1. Clinical examination and a detailed history allow diagnosis.
  2. X-rays help to evaluate the extent of any bony deformity.
  3. Ultrasound, CT and MRI scans can help to identify the extent of bursitis.

Immediate Treatment

  1. Advise appropriate shoes.
  2. Drain the bursa and advise taping / strapping.
  3. Administer a cortisone injection to reduce inflammation if indicated.

Possible Referral

  1. Refer to Podiatry for footwear advice/modification, metatarsal dome pads, biomechanical examination, possible orthotics.
  2. Surgical management may involve simply excising the bursa but may also need to address any related deformity

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