Intermetatarsal bursitis is a common cause of foot pain that is reported in females more than males. This high incidence is attributed mainly to the anatomy of the female foot as well as lifestyle choices such as the prolonged use of higher heeled shoes or long hours of standing in occupations such as the retail industry. Unfortunately, poorly managed foot pain can also aggravate the risk of developing other disorders such as neuromas

TYPICAL PRESENTATION OF BURSITIS:

  • Excruciating pain that is often pronounced in the region of third and/or fourth metatarsal space.
  • Aggravation of pain or discomfort upon weight-bearing.
  • The feeling of an electrical jolt like sensation; especially on the movement of the involved toes
  • The feeling of numbness radiating into the web-spaces
  • The sensation of walking on a marble
  • Progressive disability

However, in some cases, the two conditions (bursitis and neuroma) may coexist together

DIAGNOSIS OF BURSITIS

The diagnosis of bursitis is mostly clinical i.e. more than 85-90% cases can be identified on good history taking and clinical examination. For more complex or concealed cases, radiological tests like an ultrasound or magnetic resonance imaging (MRI) may be needed.

 

Bursitis can be differentiated from the Morton neuroma on scans via following features:

  • Morton’s neuroma appears as a patchy enhancement (which is actually perineural fibrosis). The lesion is characteristic of a tear-drop shaped mass of soft tissue; usually along the plantar aspect of metatarsal heads.
  • Bursitis appears brighter and has signs of rim enhancement. Often bursitis may show signs of fluid accumulation around the tissues due to ongoing inflammation.

MANAGEMENT OF BURSITIS

Generally, no management or clinical workup is necessary if bursitis is pain-free and identified accidentally on physical examination. For painful or disturbing bursitis, the choice of therapy depends on overall health and patient factors.

Most common management tools to control the symptoms of these two conditions primarily revolves around:

  • Lifestyle modification and changes in the activity status
  • Modification on the type of footwear

In chronic cases:

  • Cortisone injection or analgesic injections may be used to resolve pain and active inflammation
  • If these are not helpful, surgery is an excellent treatment choice
  • Surgery is usually the last resort after all other options have been tried.

References:

  1. Bauer, T., Gaumetou, E., Klouche, S., Hardy, P., & Maffulli, N. (2015). Metatarsalgia and Morton’s Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up. The Journal of Foot and Ankle Surgery, 54(3), 373-377.
  2. Zanetti, M., Strehle, J. K., Zollinger, H., & Hodler, J. (1997). Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology, 203(2), 516-520.
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