Intermetatarsal Bursitis


What is intermetatarsal bursitis 

Intermetatarsal bursitis is controversial:

  • Some studies indicate that the inter metatarsal bursa and that pathology (bursitis) does not exist.
  • Some suggest that inter metatarsal bursitis occurs  as an isolated problem.
  • There are others that say that intermetarasal bursitis exists in combination with a interdigital neuroma referred to as a “bursal- neuromal complex”(2).

Similar to a neuroma bursitis  often presents as pain on the ball of the foot. Neurological symptoms are less common with bursitis but can also occur as the bursa can push on the common plantar nerve resulting in burning, tingling, numbness and pain in the region of the forefoot (1).


Causes of Intermetatarsal Bursitis

The exact cause of an interdigital bursitis  is unclear. It is thought that the inter metatarsal bursitis is the result of compression trauma a Intermetatarsal bursa

(see the diagram below of a cross section of the forefoot).
It has been suggested that the bursa is repeatedly compressed between the bottom of the foot.  The result is a chronic irritation of the bursa results in irritation of the bursa.


The irritation of the bursa is thought to be made worse with:


Diagnosis of Intermetarasal bursitis

Diagnosis is usually based or symptoms and a complete assessment of your foot and ankle.

At the Foot an Ankle Centre we are able to provide additional information about the presence of a neuroma with ultrasound imaging.

Typically a a bursa similar to a neuroma will present as a compressible mass between the web space as shown in the picture above and the video below.


Treatment of a Intermetarsal bursitis

Treatment aims to reduce the irritation of the bursa and also offload the forefoot to prevent its re-occurrence.

Reduction of the disorganised mass can include

  • Ultrasound guided injection therapy

Offloading the interdigital mass can  be achieved with

  • Shoe stretching and modification (rocker sole modification)
  • Metatarsal domes
  • Custom made Orthotics with a metatarsal dome incorporated into the design
    Before modification After modification
    Take note of where the metatarsal heads are It is very important that the metatarsal dome extends 1-2cm distally from the metatarsal heads as this is how much the foot moves in a shoe.

What else could it be? (differential diagnosis)

Other problems that can cause similar pain to a neuroma include:

Bursal Neuromal Complex

Mortons Neuroma

Interdigital Neuroma 

Corns

Plantar plate pathology

Friebergs infraction

Metatarsal stress fracture

 


 

The Ankle, Foot and Orthotic Centre’s Northcote Podiatrists can help you with all lower limb complaints, including Neuroma. Make an appointment to get your foot and ankle pain under control.

Expert Podiatrists for the treatment of Neuromas servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston

Call The Ankle Foot and Orthotic Centre for diagnosis and advice on professional management and treatment options.

 


References

  1. Bossley CJ, Cairney PC. The intermetatarsophalangeal bursa–its significance in Morton’s metatarsalgia. J Bone Joint Surg Br. 1980;62-B(2):184-7.
  2. 4.Cohen SL, Miller TT, Ellis SJ, Roberts MM, DiCarlo EF. Sonography of Morton Neuromas: What Are We Really Looking At? J Ultrasound Med. 2016;35(10):2191-5.
  3. Zanetti M, Weishaupt D. MR Imaging of the Forefoot: Morton Neuroma and Differential Diagnoses. Seminars In Musculoskeletal Radiology. 2005;09(03):175-86