Plantar metatarsal bursitis

What is Plantar metatarsal bursitis?

A bursa is a fluid filled space and are normal anatomical features that are with us from birth. Bursitis is a bursa that has been aggravated and has become inflamed. Some bursae are not present at birth but develop due to excessive friction and pressure, these are known as adventitious bursae.
Plantar metatarsal bursitis is an adventitious bursa on the sole of the forefoot area that is not an uncommon cause of metatarsalgia.

Symptoms of Plantar metatarsal bursitis?

  • Pain – when weight-bearing and felt when pressing the underneath aspect of the metatarsal head (knuckle).
  • Soft lump or ‘puffiness’ – normally present on the sole adjacent to bony prominences of the knuckles.

Causes of Plantar metatarsal bursitis?

  • The vast majority are caused by a recent history of ‘over use’. Excessive & repeated activities that constantly expose the forefoot area to excessive friction & pressure. Regular wearing of heeled footwear can also contribute. They develop at sites where subcutaneous tissue is exposed to friction and high pressure.

How to diagnose plantar metatarsal bursitis?

  • History & Examination
  • Ultra-sound scans / imaging – Plantar metatarsal bursitis can easily be misdiagnosed and therefore we may advise an Ultra-sound scan / imaging to be undertaken by our ‘in house’ musculoskeletal specialist Sonographer to confirm the diagnosis.

How do we treat Plantar metatarsal bursitis?

  • Rest & Avoidance – Identify the cause(s) and refrain from activities triggering the condition eg excessive gym work, gymnastics, jogging, etc. Without avoidance & rest the condition will not improve.
  • Change of footwear & redistributive insoles
  • Low level laser treatments – some patients will report a reduction in symptoms.
  • Corticosteroid injection – if symptoms are chronic and have not responded significantly to rest & avoidance then we will consider offering patients a small volume corticosteroid injection. The area will be numbed first with a local anaesthetic and our musculoskeletal specialist Sonographer will use Ultrasound imaging to help the Podiatrist to guide the cortisone injection into the bursal sac. Significant relief of symptoms would normally be expected for the vast majority of patients following these injections.