Intermetatarsal bursitis is inflammation of the small, fluid-filled sacs located between the long bones in the ball of your foot. These sacs, called bursae, normally help reduce friction as you walk. When they become irritated and swollen, they can cause pain, tenderness, and sometimes numbness or tingling between the toes.
The discomfort can feel similar to Morton’s neuroma, which is why an accurate diagnosis is important. Most patients can be treated without surgery, but persistent cases may benefit from removing the inflamed bursa.
Understanding Intermetatarsal Bursitis
The five metatarsal bones connect your toes to the middle of your foot. Small bursae sit between these bones and help cushion the surrounding tissues.
Intermetatarsal bursitis develops when one of these bursae becomes inflamed. This can happen from repeated pressure, irritation, an injury, or an underlying inflammatory condition such as rheumatoid arthritis.
People who spend long periods standing or walking, participate in repetitive activities, or wear tight shoes may be more likely to develop this condition. Foot structure, including flat feet, high arches, or misalignment of the metatarsal bones, can also contribute.
In patients with rheumatoid arthritis or other autoimmune conditions, inflammation may affect the bursae along with the joints and tendons of the foot.
Symptoms of Intermetatarsal Bursitis
The most common symptom is pain in the ball of the foot, often between the second and third toes. The pain may feel sharp, burning, or aching and typically becomes worse when walking, standing, or wearing tight shoes.
Other symptoms include tenderness or swelling between the metatarsal bones, numbness or tingling in nearby toes, and discomfort that improves with rest. Patients with rheumatoid arthritis may also experience joint stiffness, swelling, or toe deformities.
Because these symptoms overlap with Morton’s neuroma and other forefoot conditions, a proper evaluation is important.
Diagnosis and Evaluation
Your doctor will begin with a physical examination, checking the location of your pain, tenderness, and swelling. Your symptoms and medical history, including any history of rheumatoid arthritis, will also help guide the evaluation.
Ultrasound can identify an enlarged or inflamed bursa. An MRI provides a more detailed view of the soft tissues and can help distinguish intermetatarsal bursitis from Morton’s neuroma, stress fractures, and other causes of forefoot pain.
If an inflammatory condition is suspected, blood tests may also be recommended.
Non-Surgical Treatment Options
Treatment usually begins with reducing pressure and inflammation in the affected area. Many patients improve without surgery.
Your doctor may recommend wider shoes with a roomy toe box to reduce pressure across the ball of the foot. Custom orthotics can help redistribute weight and take pressure off the inflamed bursa.
Rest, ice, and anti-inflammatory medications may help reduce discomfort. Physical therapy can address flexibility, stretching, and walking mechanics. In some cases, a corticosteroid injection may be considered to reduce persistent inflammation.
If rheumatoid arthritis is contributing to the problem, treating the underlying condition is important. Medications prescribed by a rheumatologist may help control inflammation and reduce the risk of further joint problems.
Surgical Treatment
Surgery may be considered when pain continues despite appropriate non-surgical treatment and the inflamed bursa is confirmed as the source of symptoms.
The procedure, called an intermetatarsal bursa excision (CPT 28090), involves removing the inflamed bursa to relieve pressure and irritation between the metatarsal bones.
The surgeon makes a small incision over the affected area, carefully identifies and removes the inflamed bursa, and closes the incision with sutures. A sterile dressing and protective postoperative shoe are used to protect the foot during healing. The procedure is generally performed on an outpatient basis.
Surgery is not necessary for every patient. Your doctor will consider the severity of your symptoms, imaging findings, foot structure, and response to conservative treatment before recommending it.
Recovery After Surgery
Recovery depends on the extent of the inflammation, the procedure performed, and your overall health. Patients generally need to limit activity, keep the foot elevated, and protect the surgical area during the initial healing period.
The initial recovery period is typically two to three weeks, with more complete recovery taking approximately six to eight weeks. Your doctor will guide your return to regular walking and activity. Physical therapy may be recommended to restore strength, flexibility, and mobility.
Risks and Possible Complications
As with any surgery, bursa excision carries some risks. These may include infection, delayed wound healing, nerve irritation, numbness between the toes, scar sensitivity, and recurrence of inflammation if the underlying source of pressure is not addressed.
Your surgeon will discuss the potential risks and expected benefits based on your individual condition.
Long-Term Outlook
Most patients improve with appropriate treatment and are able to return to normal daily activities. Addressing contributing factors, such as footwear, abnormal pressure, or inflammatory disease, is important for maintaining long-term relief.
If you have rheumatoid arthritis, continued management of the underlying condition is especially important because inflammation can affect other joints and soft tissues in the foot.
When to See a Specialist
You should have your foot evaluated if you experience persistent pain in the ball of your foot, particularly if it does not improve with rest, supportive footwear, or other basic treatments. Early evaluation can help identify the cause and prevent ongoing discomfort.
Seek urgent medical attention if you develop severe swelling, redness, warmth, or an inability to walk, as these symptoms may indicate an infection or another serious problem.
Insurance and Cost
We work with Medicare, most commercial insurance carriers, including Aetna, Anthem BCBS, Cigna, Empire BCBS, and UnitedHealthcare, as well as most workers’ compensation and no-fault insurance carriers.
Coverage for intermetatarsal bursa excision depends on your insurance plan and whether the procedure meets medical necessity requirements. Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss any expected out-of-pocket costs.
For a full list of accepted insurance plans and patient billing information, visit our Insurance Information page.
The content on this page has been authored, edited, or approved by the doctors below, and was last reviewed for accuracy on November 12, 2026.
