Metatarsalgia Part II: Bursitis or not bursitis; that is the question.
Welcome to Part II of our 3 part series on metatarsalgia – intermetatarsal bursitis. Just to refresh your memory, Metatarsalgia is a broad term used to describe pain around the ball of the foot – the padded area just back from your toes. There are a number of problems that cause metatarsalgia so the generalized diagnosis is often not helpful in explaining why you might be in pain. It’s also not helpful for developing a treatment plan as the different conditions that make up metatarsalgia all require very different approaches. Last month we talked about Morton’s neuroma (if you missed Part I last month, you can read it here) This month’s subject, intermetatarsal bursitis, is often seen alongside a neuroma and can quite often be the cause of a neuroma.
What is a bursa?
A bursa or bursae are small, fluid-filled sacs present all over the body. They are there to help reduce friction between bone and tendon but can also form in other areas if there is enough rubbing and pressure present. When these sacs become inflamed, it is called bursitis.
This describes inflammation of the bursae that lie between the ends of the metatarsals (long bones) of the feet. This is caused by:
Excessive pronation or ‘rolling in’ – this causes friction between one side of the foot and the other while walking which rubs the bursae and causes them swell
Tight shoes cause a squeezing of the forefoot which again causes rubbing of the bursae and subsequent swelling
High-heeled shoes lead to a hyperextension or over-bending of the toes, which causes the fluid inside the bursae to move toward the toes. With the increased weight-bearing on the balls of the feet and therefore pressure and friction on the bursae this then leads to inflammation
What does it feel like?
Burning, pinching, sharp pain is often described with swelling noted on the top of the foot. It can often feel like you’re walking on a stone or rock and if it is pressing on a nerve, you might also experience shooting pain or numbness in the toes.
What is the treatment?
As the cause is often footwear related, treatment is pretty simple – stop wearing the shoes that are causing it! However, sometimes the swelling is so bad that it hurts no matter what shoes you wear. A full assessment of your footwear and biomechanics is needed to determine whether insoles or orthoses may be needed. An ultrasound is helpful to diagnose any other associated conditions such as neuroma or plantar plate tears (more on this next month), which can often be present at the same time.
Anti-inflammatory medication can help reduce the swelling as can a cortisone injection, however, these won’t have long-lasting effects if the underlying cause isn’t dealt with.