From the Guidelines
To treat intermetatarsal bursitis with orthotics, I recommend using custom-molded orthotic inserts with specific metatarsal pads or domes positioned just proximal to the affected intermetatarsal space, in conjunction with a semi-rigid shell, adequate arch support, and a soft, shock-absorbing top cover, as this approach has been shown to effectively redistribute pressure away from the inflamed bursa and improve foot biomechanics 1.
Key Components of Orthotic Therapy
- Custom-molded orthotic inserts with metatarsal pads or domes to redistribute pressure
- Semi-rigid shell to provide adequate arch support and improve foot biomechanics
- Soft, shock-absorbing top cover to enhance comfort
Additional Conservative Measures
- NSAIDs, such as ibuprofen (400-600mg three times daily with food for 7-10 days), to reduce inflammation
- Regular ice application (15 minutes, 3-4 times daily) to reduce pain and inflammation
- Temporary activity modification to reduce stress on the affected area
Importance of Proper Footwear
- Supportive, properly fitted shoes with a wide toe box to accommodate orthotics and reduce pressure on the foot
- Avoidance of conventional footwear or standard therapeutic footwear over offloading devices, as recommended by the IWGDF guidelines 1
Expected Outcomes
- Significant improvement within 2-4 weeks of consistent orthotic use
- Complete resolution may take 6-8 weeks depending on severity Note: While the provided evidence primarily focuses on offloading foot ulcers in persons with diabetes, the principles of orthotic therapy and pressure redistribution can be applied to the treatment of intermetatarsal bursitis, with a focus on improving foot biomechanics and reducing pressure on the affected area 1.
From the Research
Treatment of Intermetatarsal Bursitis with Orthotics
- Orthotic devices are considered a useful treatment modality for intermetatarsal bursitis, as they can help reduce pressure and friction on the affected area 2.
- The use of orthotics, along with other conservative treatments such as shoe modifications, muscle strengthening, and contrast baths, can provide relief from symptoms of intermetatarsal bursitis 2.
- In cases of chronic intermetatarsal bursitis, orthotic devices may be necessary to provide permanent relief 2.
- While there is limited direct evidence on the use of orthotics for intermetatarsal bursitis, studies on related conditions such as intermetatarsal compression neuritis suggest that orthotics can be an effective part of a conservative treatment approach 3.
Related Conditions and Treatments
- Intermetatarsal bursitis can be associated with other conditions, such as rheumatoid arthritis, and may require surgical treatment in some cases 4.
- The intermetatarsophalangeal bursa has been implicated in the pathogenesis of Morton's metatarsalgia, and inflammatory changes in this bursa may contribute to symptoms of intermetatarsal bursitis 5.
- Conservative treatments, such as aspiration, rest, ice, immobilization, and injection of corticosteroids, may be effective for other types of bursitis, such as knee bursitis 6.