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Second Metatarsophalangeal Capsular Bursa

bursa capsularis articulationis metatarsophalangealis secundae

A small bursa develops at the plantar capsule of the second MTP joint, between the plantar plate and the overlying intrinsic tendons, in response to repetitive plantar pressure and reactive synovitis. It is associated with second MTP instability from plantar plate attenuation, which produces transfer metatarsalgia and the second toe crossover deformity.

Region: Foot & Ankle

Clinical Relevance

Clinical Notes

Second MTP capsular bursitis presents as plantar forefoot pain at the second metatarsal head level, point tenderness directly beneath the second MTP, and swelling. The drawer test (dorsal force on the proximal phalanx) demonstrates instability from plantar plate attenuation. Ultrasound demonstrates the bursal fluid collection and plantar plate tear. Corticosteroid injection into the bursa provides symptomatic relief but may worsen plantar plate integrity; plantar plate repair with tendon transfer addresses the underlying instability.

Pathology

Common Injuries & Conditions

Second MTP Bursitis with Plantar Plate Instability

Second MTP synovitis and capsular bursitis from plantar plate attenuation produces plantar forefoot pain with a positive MTP drawer test indicating joint instability; corticosteroid injection provides temporary relief but direct plantar plate repair with a bone anchor and flexor-to-extensor tendon transfer corrects the instability and crossover deformity.