From the Research
Intermetatarsal bursitis can be effectively treated with a combination of conservative measures, including rest, ice, and non-steroidal anti-inflammatory drugs (NSAIDs), as well as medical interventions such as corticosteroid injections, with the goal of reducing morbidity, mortality, and improving quality of life. The treatment approach should prioritize conservative measures, with medical interventions reserved for severe or persistent cases.
Conservative Measures
- Resting the affected foot and avoiding activities that cause pain
- Applying ice to the painful area for 15-20 minutes several times daily to reduce inflammation
- Taking NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) to manage pain and inflammation
- Wearing properly fitting, supportive shoes with a wide toe box to reduce pressure on the metatarsal heads
- Using metatarsal pads or cushioned insoles to redistribute pressure away from the inflamed bursa
- Physical therapy exercises that stretch and strengthen the foot muscles can help improve foot mechanics
Medical Interventions
- For persistent cases, a corticosteroid injection (typically methylprednisolone 40mg mixed with local anesthetic) directly into the bursa may provide relief, as supported by a study on ultrasound-guided steroid injection in the treatment of interdigital neuralgia 1
- In rare cases where conservative treatment fails after several months, surgical removal of the bursa might be necessary It is essential to note that intermetatarsal bursitis can be a manifestation of underlying rheumatological disorders, as suggested by a study on intermetatarsal bursitis as a novel feature of juxtaarticular inflammation in early rheumatoid arthritis 2. Therefore, a thorough evaluation and diagnosis are crucial to determine the underlying cause of the condition. The most recent and highest quality study on this topic is from 2022, which highlights the importance of early diagnosis and treatment of intermetatarsal bursitis in patients with rheumatoid arthritis 2. This study suggests that intermetatarsal bursitis is a frequently present novel feature of juxtaarticular synovial inflammation in early rheumatoid arthritis, and its treatment response is similar to other local inflammatory measures. In clinical practice, it is crucial to prioritize the patient's quality of life, morbidity, and mortality when making treatment decisions. A study from 2019 emphasizes the importance of awareness of intermetatarsal bursitis as a potential manifestation of rheumatological diseases, which can help make a more accurate and prompt diagnosis 3. Overall, the treatment of intermetatarsal bursitis should be individualized, taking into account the patient's underlying condition, symptoms, and response to treatment, with the goal of reducing morbidity, mortality, and improving quality of life.