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First MTP Medial Bursa

bursa adventitia articulationis metatarsophalangeae primae medialis

The medial first MTP bursa is an adventitial bursa forming over the medial first metatarsal head prominence in hallux valgus, where the deviated great toe causes the metatarsal head to protrude medially beneath the skin. The bursa develops in response to repetitive friction and pressure between the medial metatarsal head and footwear, forming the classic 'bunion' sac. It is not a constant anatomical structure but develops secondary to the deformity.

Region: Foot & Ankle

Clinical Relevance

Clinical Notes

The medial MTP bursa is the inflamed, often infected, painfully swollen component of the symptomatic bunion complex. Bursal aspiration may reveal serous, haemorrhagic, or purulent fluid (septic bursitis requiring antibiotic treatment). Conservative management of bunion pain includes wider toe-box footwear to reduce bursal pressure, silicone medial padding, and corticosteroid injection into the bursa for acute inflammation. Surgical hallux valgus correction eliminates the bony prominence and allows the bursa to resolve — the bursa itself is excised as part of the medial capsulotomy and exostectomy.

Pathology

Common Injuries & Conditions

Septic Bunion Bursitis from Footwear Trauma

Direct footwear pressure ulceration over the medial first MTP bursa produces portal of entry for skin bacteria, causing septic bursitis with erythema, warmth, and purulent bursal aspiration; intravenous antibiotics targeting skin flora are required and surgical incision and drainage is indicated for abscess formation or failure to respond to antibiotics within 48 hours.