A small adventitial bursa may develop over the extensor hallucis longus tendon at the level of the first metatarsophalangeal joint or over the dorsal midfoot, where the tendon crosses bony prominences. It develops in response to tight shoe pressure against the thin skin of the dorsal foot, particularly with high-arched feet or with the prominent dorsal osteophytes of hallux rigidus.
EHL dorsal bursitis produces a painful fluctuant swelling over the dorsal great toe MTP or dorsal midfoot that is worsened by shoe pressure. On ultrasound it appears as a hypoechoic collection adjacent to the EHL tendon without intratendinous changes. Management focuses on footwear modification (wide-toed shoes, no lacing over the prominence), protective padding, and aspiration with corticosteroid injection if symptomatic. In hallux rigidus with dorsal osteophytes, the bursa overlies the osteophytic bony prominence and may require osteophyte removal for definitive relief.
A dorsal osteophyte at the first MTP joint in hallux rigidus irritates the EHL tendon and overlying skin, producing a tender bursa over the prominence that is managed with shoe modification and injection, with surgical osteophyte excision (cheilectomy) providing definitive relief.
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