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
- Pain and tenderness over the location of the bursa. (lateral squeeze test may reproduce pain)
- Swelling over the location of bursa.
- Loss of motion of the foot.
- Pain with activities like walking, jumping, running.
Tests and Imaging
- Clinical examination and a detailed history allow diagnosis.
- X-rays help to evaluate the extent of any bony deformity.
- Ultrasound, CT and MRI scans can help to identify the extent of bursitis.
Immediate Treatment
- Advise appropriate shoes.
- Drain the bursa and advise taping / strapping.
- Administer a cortisone injection to reduce inflammation if indicated.
Possible Referral
- Refer to Podiatry for footwear advice/modification, metatarsal dome pads, biomechanical examination, possible orthotics.
- Surgical management may involve simply excising the bursa but may also need to address any related deformity
