From the Research
Bursal distension at the 5th metatarsophalangeal joint (MTPJ) is primarily caused by chronic friction and pressure, typically from ill-fitting footwear that compresses the lateral aspect of the foot. This condition, often called a tailor's bunionette or bunionette bursitis, develops when the protective bursal sac between the 5th metatarsal head and overlying skin becomes inflamed and fills with fluid. Management begins with conservative measures including:
- Wearing wider shoes with adequate toe box space
- Using protective padding or silicone sleeves over the prominence
- Taking NSAIDs such as ibuprofen (400-600mg three times daily with food) for pain and inflammation, as supported by general medical knowledge and not specifically mentioned in the provided studies 1, 2, 3, 4, 5 Ice application for 15-20 minutes several times daily can help reduce acute inflammation. For persistent cases, a corticosteroid injection (typically methylprednisolone 40mg mixed with local anesthetic) into the bursa may provide relief, as shown in a study on pes anserine bursitis treatment 4. Physical therapy focusing on proper foot mechanics and stretching exercises can address contributing biomechanical factors. Custom orthotic devices may redistribute pressure away from the prominent 5th metatarsal head. Surgery is reserved for cases that fail conservative management, with procedures including bursal excision, lateral condylectomy of the 5th metatarsal head, or osteotomy to realign the metatarsal. The condition develops because the bursa, which normally facilitates smooth movement between tissues, responds to excessive friction by producing more synovial fluid, leading to distension and pain when the protective mechanism is overwhelmed, as explained in the context of bursae anatomy and pathology 2. It's worth noting that while the provided studies discuss various types of bursitis and their management, the most recent and relevant study to the question of bursal distension management is 4, which compares the efficacy of different treatments for pes anserine bursitis, but the principles of management can be applied to other forms of bursitis, including that at the 5th MTPJ.