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Third Metatarsophalangeal Bursa

bursa articulationis metatarsophalangeae tertiae

The third MTP joint bursa is a small synovial extension of the third MTP joint space that, when distended, produces a palpable plantar forefoot mass and pain in the third metatarsal head region. It is distinct from the third interdigital web space Morton neuroma bursa, lying specifically at the plantar aspect of the third MTP joint. Third metatarsalgia and third MTP synovitis are commonly associated with second ray instability (second MTP plantar plate insufficiency causing load transfer to the third MTP).

Region: Foot & Ankle

Clinical Relevance

Clinical Notes

Third MTP bursitis produces plantar forefoot pain under the third metatarsal head, reproduced by dorsal-plantar compression of the third MTP joint (grind test) and by palpation from the plantar surface. Ultrasound demonstrates the hypoechoic bursitis fluid around the third MTP joint capsule. Corticosteroid injection into the third MTP joint and its adjacent bursa provides symptomatic relief. Persistent bursitis with plantar plate instability at the third MTP may require plantar plate repair or metatarsal shortening osteotomy to reduce metatarsalgia and offload the bursal space.

Pathology

Common Injuries & Conditions

Third MTP Bursitis from Lateral Load Transfer in Second Ray Instability

Second MTP plantar plate insufficiency allowing dorsal second toe subluxation increases loading on the adjacent third metatarsal head, producing third MTP synovitis and bursal distension as a secondary metatarsalgia; ultrasound-guided third MTP injection and second MTP plantar plate repair addresses the primary instability and reduces the secondary bursitis.