Intermetatarsal Bursitis

Intermetatarsal bursitis is a well-known cause of forefoot pain. Intermetatarsal bursae are positioned between the interosseous tendons of the feet dorsal to the deep transverse metatarsal ligament. They are positioned to act as lubricants where tendons move against each other or glide over bone surfaces.

The first intermetatarsal bursa covers the adductor hallucis tendon laterally and is positioned medial to the dorsal interosseous tendon. The second through fourth intermetatarsal bursa are positioned between the dorsal interosseous (medial) and plantar interosseous (lateral) tendons.

In the anteroposterior direction, the bursae in the second and third intermetatarsal spaces extend about 1 cm distal to the deep transverse metatarsal ligament, while those of the first and fourth spaces do not. Inferiorly, the bursae are in close proximity to the neurovascular bundles.

Biomechanically, it is thought that tight and narrow shoes compress the bursae and lead to inflammation, causing pain that may be local or radiate to the toes.

Treatment involves reversing the pressure on the bursae, either through better-fitting (wider) shoes or the use of a rocker bar (to decrease pressure on the metatarsals). Local injection of steroid and/or local anesthesia can also help.

References

• Bossley CJ, Cairney PC. The intermetatarsophalangeal bursa--its significance in Morton's metatarsalgia. J Bone Joint Surg Br. 1980 May;62-B(2):184-7.
• Sheon RP. Patient information: Bursitis. Up-to-date
• Theumann NH, Pfirrmann CW, Chung CB, Mohana-Borges AV, Haghighi P, Trudell DJ, Resnick D. Intermetatarsal spaces: analysis with MR bursography, anatomic correlation, and histopathology in cadavers. Radiology. 2001;221(2):478-84.