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Softening the Blow: Dealing with Submetatarsal Bursitis

Submetatarsal bursitis is a condition that occurs when the bursa, a small fluid-filled sac located in the ball of the foot, becomes inflamed. When the bursa becomes inflamed, it can cause pain and swelling in the ball of the foot especially under the metatarsal heads; it can be tender to the touch; and you may have difficulty walking on the affected foot. The condition causes forefoot pain with symptoms similar to those of Morton’s neuroma (MN) and has also been associated with early rheumatoid arthritis. 

What causes Submetatarsal Bursitis?

Submetatarsal bursitis is typically caused by repetitive friction, pressure, or irritation in the ball of the foot, particularly under the metatarsal heads. The metatarsal heads are the bones in the middle part of the foot, just before the toes. The bursa is located in this region to cushion and reduce friction between bones, tendons, and muscles. When this bursa becomes inflamed, it leads to submetatarsal bursitis. 

Several factors can contribute to the development of this condition:

  • Repetitive Stress: Activities that involve repetitive stress on the forefoot, such as running, jumping, or prolonged standing, can contribute to irritation and inflammation of the bursa.
  • Improper Footwear: Wearing shoes that do not provide adequate support or have insufficient cushioning can increase pressure on the metatarsal heads, leading to irritation of the bursa.
  • Foot Deformities: Structural abnormalities in the foot, such as bunions or hammertoes, can alter the distribution of weight and pressure, contributing to the development of bursitis.
  • Tight or Ill-fitting Shoes: Shoes that are too tight or have a narrow toe box can squeeze the toes and increase pressure on the metatarsal heads.
  • Trauma or Injury: Direct trauma to the forefoot, such as dropping a heavy object on the foot or stubbing the toe, can cause inflammation of the submetatarsal bursa.
  • Medical Conditions: Certain medical conditions, such as rheumatoid arthritis or gout, may increase the risk of developing bursitis.
  • Overuse or Excessive Activity: Engaging in activities that place excessive strain on the forefoot without proper rest can lead to inflammation of the bursa.

It's often a combination of these factors that contributes to the development of submetatarsal bursitis. Addressing the underlying causes, such as choosing appropriate footwear, eliminating certain activities, and addressing foot deformities with a medical professional can help prevent the recurrence of bursitis and promote overall foot health. It's important to seek medical attention for a proper diagnosis and treatment plan.

How do you diagnose metatarsal bursitis?

specialist examining patient foot

To diagnose submetatarsal bursitis, a healthcare professional will assess your symptoms and conduct a physical examination to identify areas of tenderness, swelling, and pain. The healthcare professional will ask for information about your medical history, including any recent trauma or overuse of the foot that can help in diagnosis. The exam may include imaging studies such as X-rays, ultrasound, or an MRI in order to rule out other possible conditions and also to closely visualize the affected area.

How is metatarsal bursitis treated?

person resting foot in cast

The treatment should include:

  • Giving the foot time to rest
  • Avoiding activities that exacerbate the condition
  • Applying ice packs to the affected area to help reduce inflammation and alleviate pain
  • Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce pain and inflammation.
  • Wearing customized orthotics (shoe inserts) or pads to provide support and relieve pressure on the affected area.
  • Wearing comfortable, well-fitted shoes with good arch support to help alleviate symptoms
  • Doing stretching and strengthening exercises to improve foot function and to prevent recurrence

The prognosis for submetatarsal bursitis is generally good with appropriate treatment. Most individuals experience relief from symptoms by following the conservative measures mentioned above. In some cases, more invasive interventions such as corticosteroid injections may be considered if conservative methods do not provide sufficient relief. 

Do you need surgery for metatarsal bursitis?

doctor examining foot x ray

Surgery for submetatarsal bursitis is generally considered a last resort and is only recommended when conservative treatments have failed to alleviate symptoms. The specific surgical procedure may vary depending on the severity of the condition, the underlying causes, and the surgeon's approach. 

Here are some common surgical interventions for submetatarsal bursitis:

  • Bursal Excision: In some cases, the surgeon may opt to remove the inflamed bursa entirely. This is known as bursal excision. The removal of the bursa aims to eliminate the source of inflammation and reduce pain.
  • Metatarsal Osteotomy: If the submetatarsal bursitis is associated with structural abnormalities or deformities, a metatarsal osteotomy may be performed. Metatarsal osteotomy involves cutting and repositioning the metatarsal bone to improve weight distribution and alleviate pressure on the affected area.
  • Soft Tissue Procedures: Soft tissue procedures may involve releasing tight ligaments or tendons that contribute to increased pressure on the bursa. This can be done to address issues such as tightness or contractures in the foot.
  • Correction of Underlying Deformities: Surgical correction of underlying foot deformities, such as bunions or hammertoes, may be performed to improve foot mechanics and reduce stress on the metatarsal heads.
  • Synovectomy: In cases where inflammation extends beyond the bursa into the joint lining (synovium), a synovectomy may be performed to remove the inflamed tissue.

It's important to note that surgery is typically rare and performed only after conservative treatments have been exhausted. Most cases of submetatarsal bursitis can be successfully managed with rest, orthotics, proper footwear, anti-inflammatory medications, and physical therapy. Surgery is reserved for situations where these conservative measures do not provide relief, and the condition significantly impairs the individual's quality of life. As with any surgical procedure, there are potential risks and complications, and the decision to undergo surgery should be carefully discussed between the patient and their healthcare provider. 

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