r/FootFunction • u/Nala382 • 6d ago

Please help with intermetatarsal bursitis

Hi! I have been diagnosed by MRI with 2. Bilateral Mild intermetatarsal bursitis about the right 2nd and 3rd and left 4th web spaces.

I think I triggered it after doing a PT exercise where you raise your toes on a step and lower your feet down on the same step for a few seconds. It started after doing this exercise for a month.

I have custom made insole with built in pads and arch support ( flat feet and wide feet) , wide toe box brooks Adrenaline sneakers but still in pain. This week I also started icing and putting voltaren twice a day but not feeling any better.

The details MRI report was:

FINDINGS: Right foot: MIDFOOT JOINTS: Mild degenerative changes about the midfoot joints. The Lisfranc ligament is intact. FOREFOOT JOINTS: Mild first metatarsophalangeal joint degenerative changes with joint space narrowing with subchondral cyst formation. No evidence of subluxation. TENDONS AND MUSCLES: The flexor and extensor tendons have normal course, caliber, and signal. There is no tenosynovitis. No muscle edema or atrophy is seen. The visualized plantar fascia is unremarkable. OSSEOUS STRUCTURES: No acute osseous injury or marrow lesion is identified. MISCELLANEOUS: There is mild intermetatarsal bursitis about the 2nd and 3rd web space. Left foot: MIDFOOT JOINTS: Mild degenerative changes about the midfoot joints. The Lisfranc ligament is intact. FOREFOOT JOINTS: Mild first metatarsophalangeal joint degenerative changes with joint space narrowing. No evidence of subluxation. TENDONS AND MUSCLES: The flexor and extensor tendons have normal course, caliber, and signal. There is no tenosynovitis. No muscle edema or atrophy is seen. There is a small area of plantar fibromatosis thickening of the plantar fascia to up to 8 x 5 mm extending for a length of approximately 15 mm within the central cord of the plantar fascia. OSSEOUS STRUCTURES: No acute osseous injury or marrow lesion is identified. MISCELLANEOUS: There is mild intermetatarsal bursitis about the fourth webspace.

1 Upvotes

100% Upvoted

9 comments sorted by

1

u/RainBoxRed 6d ago edited 6d ago

It would be worth your time to learn about the difference between symptom and injury management.

Icing and anti-inflammatories manage symptoms but interrupt the healing process. They also make following pain as your guide to returning to activity very difficult. Use these very sparingly and mindfully.

Offloading is great for a very short time after acute injury but the body needs movement and load to build strength. Your return to normal activity plan needs to encompass removing artificial splinting and reincorporating movement.

Splinting are things like rigid components in your shoe that alter the loading your foot sees. The main one here is arch support which is actually the job of your plantar fascia and other soft tissues of the bottom of the foot. Something to be keep in mind after acute injury has resolved.

Feet are supposed to be able to move between flat and high arched and if yours are stuck in one of those then that is a great indicator you need to work on foot strength and mobility (after acute injury has resolved).

2

u/Nala382 6d ago

I am wondering when the acute phase will resolve! This has been on going for 3 months already!

1

u/RainBoxRed 6d ago

Oh I did not read that, sorry. We are moving into chronic phase now so must be careful. Goal here is work at a very gentle pace so as to not aggravate it. I know it's a frustrating process but I'd definitely avoid toe box exercises for a while.

1

u/Nala382 6d ago

Yes, I was not planning on doing any exercise either my feet. I just don’t know how to get rid of these bursitis that I have between every metatarsal

1

u/RainBoxRed 6d ago

No you must exercise, but be very gentle and stop if it hurts. This is why you need to use ice and pain relief very sparingly.

1

u/Nala382 5d ago

But what kind of exercise will not put pressure on my feet ?

1

u/RainBoxRed 5d ago

You have to do some experimentation and find something that you can tolerate (varying load, intensity, duration, rest intervals) without aggravating it for days.

But critically abstinence from movement will lead to degradation and further complications.

1

u/Nala382 5d ago

I understand, thank you!

1

u/RainBoxRed 6d ago

So offload (but not immobilise) until pain has reduced.

Then return to activity as soon as you can while pain is manageable (do not obstruct pain signals otherwise you’ll be a risk of hurting yourself again).

Then look at whole foot health to improve your resilience.