The second web space interdigital bursa lies between the second and third metatarsal heads, between the digital flexor tendons and the deep transverse metatarsal ligament. Like the analogous third web space bursa, it can enlarge and mimic a Morton neuroma. It is associated with second MTP synovitis and plantar plate pathology at the second MTP joint, which are common causes of second metatarsalgia.
Second MTP interdigital bursitis is frequently associated with second MTP plantar plate pathology and crossover second toe deformity. The bursa enlarges from synovitis of the adjacent MTP joint tracking into the adjacent web space, producing forefoot pain that is clinically similar to second web space Morton neuroma. Ultrasound distinguishes the bursa (anechoic, adjacent to the MTP joint) from a true neuroma (hypoechoic nerve enlargement between the metatarsal heads). MTP joint injection and synovitis treatment addresses the underlying second MTP pathology and resolves the associated bursitis.
Second metatarsal plantar plate tear or attenuation allows MTP dorsal subluxation and synovitis, with fluid tracking into the second interdigital bursa producing combined MTP and web space pain; ultrasound demonstrates MTP joint effusion and bursal fluid in the adjacent web space and plantar plate tear on dynamic assessment.
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