Inter Metatarsal Bursitis

Inter Metatarsal Bursits

Bursitis in the foot might not be as often discussed as muscle, tendon, and ligament ailments, but bursitis is a actually a common cause of foot discomfort and pain. The average human body has about 160 bursae. Most of these are located near the major joints in the body, especially joints that perform frequent repetitive motions.

Foot Anatomy As It Relates To Bursitis

A bursa is a fluid-filled cushioning sac. They are located near tendons, ligaments, skin, and muscles that would otherwise rub directly across the surface of a bone. The bursae (plural for bursa) are very important to prevent friction, absorb shock, and decrease the wear and tear between moving structures. Think of a bursa as a piece of bubble wrap that secretes a slimy substance similar to the consistency of an egg white. Aside from the usual number of bursae found in the human body, additional bursae may develop whenever they’re needed. In other words, if an area in the foot is subjected to a great deal of stress that causes additional friction between soft tissue and bone, then additional bursa may form.

There are multiple bursae located in the forefoot area. The metatarsal bursae are located on the bottom of the foot near the base of the toes. Metatarsal bursitis most often affects the second metatarsal head (the toe next to the big toe). The metatarsophalangeal bursa is located near the base of the big toe on the inner aspect of the foot. There are also many tiny bursae that are located between the metatarsal bones in the intermetatarsal spaces, thus the term intermetatarsal bursitis is used to describe this type of bursitis.

This photo depicts the 3rd and 4th It is between the 2nd, 3rd or 4th metatarsals that Inter metatarsal bursitis is most often found.

Pain can be acute

The Common Digital Nerve as it runs between the metatarsals can also be affected creating symptoms similar to morton’s neuroma

The development of a bursa between the metatarsal heads.

This photo demonstrates a bursa in its relationship just beneath the Deep Transverse Intermetatarsal ligament.

What is Foot Bursitis?

Foot bursitis is a term used to describe an inflamed bursa in the foot. As mentioned above, inflammation of a bursa in the heel is usually termed heel bursitis.

What Causes Foot Bursitis?

Bursitis in the foot may occur after direct trauma to the foot – falls, slips, auto accidents, and sport-related impacts. However, the cause of bursitis in the forefoot is most often due to irritation to the bursa sac from repetitive use and overuse, such as during prolonged standing or frequent participation in running activities. Direct pressure applied to an area over a bursa, such as from wearing shoes that are too tight, may also be a causative factor. Certain foot and gait abnormalities, such as an abnormal toe joint, overpronation, flat feet, bunions, or hammer toes, can place additional stress on the bursa and lead to bursitis. The type of shoes worn during high-impact running, walking, and jumping activities can play a role in foot bursitis since inappropriate shoes increase the amount of shock the bursa must absorb. Obesity can also increase how much stress is placed on a bursa.

biomechanical contributing factors explained

Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the tissues running between the metatarsal heads. This chronic pinching can create a bursa. As it enlarges it than becomes more swollen and increasingly troublesome causing symptoms.

What Are The Symptoms Of Foot Bursitis?

Localised swelling, pain, tenderness, warmth, and redness
Walking barefoot, wearing tight socks, wearing tight shoes, or any other action that increases pressure over the bursa may exacerbate pain
Walking, running, and jumping motions may be especially painful
Range of motion in the joint near the affected bursa may be limited


Self treatment for Inter metatarsal bursitis

Wear wide toe box shoes

Don’t lace the forefoot part of your shoe too tight

Make sure your feet are in supportive shoes that do not squeeze your forefoot.

The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however, is control lower limb biomechanics by altering foot position during the contact phase of gait (when the foot is in contact with the ground). This can only be done by wearing a good shoe (see our shoe guide) and with orthotics (foot beds).

This is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and from helping to prevent re-injury. Overall costs for the average athlete will run into pennies per mile/hour of sport.

Orthotics are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.

If inter metatarsal pain persists seek treatment as soon as possible. The earlier conservative treatment of this condition takes place the less likely surgical excision will be required.

Inter metatarsal bursitis –

returning to sporting activity

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your inter metatarsal injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your problem recovers, not by how many days or weeks it has been since your injury occurred.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

You have full range of motion in the injured leg compared to the uninjured leg.

You have full strength of the injured leg compared to the uninjured leg.

You can jog straight ahead without pain or limping.

You can sprint straight ahead without pain or limping.

You can do 45-degree cuts, first at half-speed, then at full-speed.

You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.

You can do 90-degree cuts, first at half-speed, then at full-speed.

You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.

You can jump on both legs without pain and you can jump on the injured leg without pain.