Intermetatarsal Bursitis (IMB) is a condition that involves the inflammation of the bursae located between the metatarsal bones in the forefoot. These small sacs of fluid help reduce friction and cushion pressure points between the bones and tendons around the joints. When these bursae become inflamed, it can lead to pain and discomfort in the foot, particularly around the ball of the foot.
IMB can occur due to various reasons, including mechanical stress, injury, or systemic inflammatory diseases like rheumatoid arthritis (RA). In individuals with RA, IMB is considered a common complication, and its presence can signal early signs of the disease.
Symptoms of Intermetatarsal Bursitis
The most common symptom of IMB is forefoot pain, which often presents as a sharp, stinging sensation that worsens with walking. This pain is typically localized between the toes and may be associated with numbness in the adjacent toes. Swelling and tenderness in the affected area are also common, and the condition can mimic other disorders, such as Morton’s neuroma.
In rheumatoid arthritis patients, IMB can be accompanied by other forms of inflammation like synovitis and tenosynovitis, which also cause joint swelling, stiffness, and pain. IMB may contribute to these symptoms and make walking and daily activities more challenging.
Causes and Risk Factors
IMB can develop as a result of mechanical pressure on the feet, often due to misalignment of the bones, high-impact activities, or wearing ill-fitting shoes. It can also be an indicator of systemic conditions such as RA or other inflammatory diseases, including systemic lupus erythematosus (SLE). In these cases, the inflammation is typically linked to the body’s immune system mistakenly attacking healthy tissues, including the synovial lining of the bursae.
Diagnosis
Diagnosing IMB can be challenging due to its similarity in presentation to other conditions like Morton’s neuroma. However, modern diagnostic imaging techniques such as Magnetic Resonance Imaging (MRI) and Ultrasound (US) can provide clear insights. MRI, especially with contrast enhancement, allows for detailed imaging of the intermetatarsal bursae, helping to distinguish IMB from other conditions.
Treatment Options for IMB
Treatment for IMB varies depending on the severity of the condition and the underlying cause. For patients with inflammatory diseases like rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs) may be prescribed to reduce inflammation and control symptoms. These medications help to slow down the progression of the disease and improve overall foot function.
In cases where conservative treatments (like medications and physical therapy) are ineffective, excision of the inflamed bursa may be considered. This surgical procedure involves the removal of the bursa to alleviate pressure and reduce pain. It is generally performed when all non-surgical treatments have failed to provide relief.
Excision Surgery: What to Expect
Excision of the intermetatarsal bursa is typically performed under local anesthesia. During the procedure, the surgeon will make a small incision near the affected area, carefully remove the inflamed bursa, and then close the incision with sutures. Postoperative care may involve rest, elevation, and the use of special footwear to prevent pressure on the affected area. Physical therapy may also be recommended to improve foot strength and mobility during the recovery phase.
The success of the surgery is high, with most patients experiencing significant pain relief and improved mobility after recovery. However, as with any surgery, there are potential risks, including infection, nerve damage, and recurrence of the bursitis.
Postoperative Care and Recovery
After the excision procedure, most patients can expect to return to normal activities within 6 to 8 weeks. During the recovery phase, it is important to follow the doctor’s instructions carefully to avoid complications. This may include avoiding weight-bearing activities for a certain period and taking anti-inflammatory medications to manage pain.
Long-term Outlook
The long-term prognosis for patients who undergo excision of the intermetatarsal bursa is generally good. Pain relief is often immediate, and most individuals regain normal foot function. However, in some cases, the bursitis may recur, particularly if the underlying cause, such as rheumatoid arthritis, is not properly managed. Regular follow-ups with the orthopedic surgeon and rheumatologist are important to ensure the long-term health of the feet and to manage any systemic conditions contributing to IMB.
Conclusion
Excision of Intermetatarsal Bursitis is an effective treatment option for individuals suffering from persistent forefoot pain due to inflammation of the intermetatarsal bursae. While conservative treatments like anti-inflammatory medications and physical therapy are often successful, surgery provides significant relief for patients when these options fail. With proper diagnosis, treatment, and postoperative care, most patients can return to pain-free walking and improve their quality of life.
Do you have more questions?
Q. What is Intermetatarsal Bursitis (IMB)?
A. Intermetatarsal Bursitis (IMB) is the inflammation of the bursae located between the metatarsal bones in the foot, leading to pain, swelling, and discomfort, especially in the forefoot.
Q. What causes Intermetatarsal Bursitis?
A. IMB can be caused by mechanical pressure on the foot, misalignment of bones, high-impact activities, or systemic inflammatory conditions like rheumatoid arthritis (RA), which may lead to inflammation in the bursa.
Q. How is Intermetatarsal Bursitis diagnosed?
A. Diagnosis is made through a physical examination and imaging techniques such as MRI or ultrasound to assess the extent of the bursitis and rule out other conditions like Morton’s neuroma.
Q. What are the treatment options for Intermetatarsal Bursitis?
A. Initial treatment includes anti-inflammatory medications, custom orthotics, and physical therapy. If conservative methods fail, excision of the inflamed bursa may be considered.
Q. What is the excision procedure for Intermetatarsal Bursitis?
A. The excision procedure involves making a small incision over the affected area, removing the inflamed bursa, and then closing the incision with sutures. It is typically performed under local anesthesia.
Q. What is the recovery time after excision of Intermetatarsal Bursitis?
A. Recovery typically takes 6 to 8 weeks, with patients advised to rest and use special footwear to avoid pressure on the foot during healing.
Q. Are there risks associated with the excision of Intermetatarsal Bursitis?
A. Risks include infection, nerve damage, and recurrence of bursitis. However, these risks are rare, and the procedure is generally safe and effective for relieving pain.
Q. What is the long-term outlook after excision of Intermetatarsal Bursitis?
A. The long-term prognosis is generally good, with most patients experiencing pain relief and improved mobility, although recurrence may happen, particularly if the underlying cause is not addressed.
Q. Will I be able to walk immediately after excision of Intermetatarsal Bursitis?
A. You will need to avoid putting weight on the foot for a short period after surgery. A special shoe or walking boot will typically be worn for several weeks to protect the foot while it heals.
Q. Is physical therapy required after excision of Intermetatarsal Bursitis?
A. Physical therapy is often recommended to help restore strength, flexibility, and mobility in the foot and to prevent complications such as stiffness or muscle weakness.
Q. Can excision of Intermetatarsal Bursitis be performed as an outpatient procedure?
A. Yes, excision of Intermetatarsal Bursitis is typically performed as an outpatient procedure, meaning you can go home the same day after the surgery.
Q. How long does the excision procedure for Intermetatarsal Bursitis take?
A. The procedure typically takes about 30 to 45 minutes, depending on the complexity of the condition and the patient’s individual needs.
Q. Is there a risk of recurrence after excision of Intermetatarsal Bursitis?
A. While recurrence is uncommon, it can happen, especially if the underlying cause, such as abnormal foot mechanics or continuous pressure on the area, is not addressed.
Q. Can I return to sports after excision of Intermetatarsal Bursitis?
A. Most patients can return to low-impact activities within 6 to 8 weeks, but high-impact activities should be avoided until the foot has fully healed and strength is restored.
Q. Will the excision of Intermetatarsal Bursitis affect my foot’s appearance?
A. The procedure generally does not significantly affect the foot’s appearance, as it only involves removing the inflamed bursa and not altering the overall structure of the foot.
Dr. Mo Athar
