Intermetatarsal bursae are small bursae located in the web spaces of the forefoot between the metatarsal heads, positioned dorsal to the interdigital nerve and the deep transverse metatarsal ligament. They are most prominent in the second and third web spaces. They facilitate gliding between adjacent metatarsal heads during toe extension and push-off.
| Location | In the web spaces between adjacent metatarsal heads, dorsal to the deep transverse metatarsal ligament |
|---|---|
| Nearby |
|
Reduces friction between adjacent metatarsal heads during weight bearing and toe extension
Intermetatarsal bursae can enlarge and contribute to symptoms in the same web space as Morton neuroma, making clinical and imaging distinction important since the two structures frequently coexist. Ultrasound can differentiate a fluid-filled bursa from a hypoechoic fusiform neuroma, and MRI shows characteristic signal on T2 sequences. Second web space bursitis is often linked to synovitis and plantar plate tears of the second metatarsophalangeal joint, so that joint should be examined too. Corticosteroid injection targets the bursa effectively, and surgical excision is occasionally required when conservative treatment fails.
Bursal inflammation in the web space produces forefoot burning pain and numbness similar to Morton neuroma, often aggravated by footwear and relieved by removing shoes, treated with wide-toed shoes, metatarsal pads, and corticosteroid injection.
Intermetatarsal bursitis and Morton neuroma frequently coexist in the same web space, creating a combined mass that may require both neuroma excision and bursectomy at the time of surgery for reliable symptom relief.
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