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Plantar Metatarsal Head Bursae

bursae plantares capitum metatarsalium

Plantar metatarsal head bursae are adventitial bursae that develop between the plantar skin and the metatarsal heads in response to repetitive pressure, most commonly beneath the second and third metatarsal heads. They are distinct from the intermetatarsal bursae in the web spaces and from the first MTP bunion bursa medially. They form the body's cushioning response to forefoot overload from elevated heels, metatarsalgia, and wasting of the plantar fat pad.

Region: Foot & Ankle

Clinical Relevance

Clinical Notes

Plantar MTP bursitis contributes to metatarsalgia, with pain on walking directly under the affected metatarsal head that is distinguished from Morton neuroma by its plantar rather than web space location and by the absence of digital numbness. The plantar fat pad thins with age, diabetes, and corticosteroid use, increasing metatarsal head pressure. Metatarsal offloading pads placed proximal to the affected head reduce pressure on the bursa. When inflamed, ultrasound shows a hypoechoic fluid collection directly plantar to the metatarsal head.

Pathology

Common Injuries & Conditions

Plantar Metatarsal Bursitis and Metatarsalgia

Chronic forefoot overloading from high heels, biomechanical foot deformities, or loss of the plantar fat pad inflames the plantar metatarsal head bursae, producing burning forefoot pain on walking that improves with metatarsal pad offloading, cushioned insoles, and occasionally corticosteroid injection.