The supra-transverse intermetatarsocapital bursa: a description and its relation to painful syndromes of the forefoot

Abstract

Very many painful syndromes of the forefoot remain without a satisfactory explanation; although this region contains quite specific structures, it has suffered from the application of analogies with disorders of the hand. Among these specific components, the presence of the supra-transverse intermetatarsocapital bursa provides an explanation of such clinical entities as the acute syndrome of the second intermetatarsal space and gives fresh impetus to the debate on the etiopathogenesis of Morton's metatarsalgia. On the basis of 25 dissections, the authors studied the region between the metatarsal heads, confirming the presence of these bursae and specifying their site and size and particularly their relations with the common plantar digital nerve at its bifurcation into collateral nerves.

Comparative Distribution of Ultrasound‐Detectable Forefoot Bursae in Patients With Osteoarthritis and Rheumatoid Arthritis

“…We hypothesized that, in patients who have RA, the increased prevalence of FFB may be related to increased inflammation. This concurs with other investigators who have suggested that the synovium, which lines the otherwise inconspicuous intermetatarsal (IM) anatomical bursae, becomes hypertrophied as a consequence of excessive disease activity (). Conversely, other investigators have hypothesized that adverse mechanical pressure and shearing forces may result in the accumulation of interstitial fluid within the subcutaneous tissues, often termed adventitial bursae ().…”

Prognostic indicators of foot‐related disability in patients with rheumatoid arthritis: Results of a prospective three‐year study

“…The association between FFB and inflammatory disease has been previously documented in both histologic and cross‐sectional imaging studies (30–32). The identification of a synovial membrane within intermetatarsal FFB, with inwardly projecting villi (33), or a fibrocollagenous membrane that exhibits some superficial synoviocytic cellular elements (34, 35), appears to provide support for the notion that FFB are directly associated with disease activity. Additionally, a number of cross‐sectional imaging studies reinforce this theory, suggesting that the particular susceptibility of FFB, above other synovial structures, makes them a clinically useful and representative feature of minimal disease activity (32, 36, 37).…”

Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: A twelve‐month investigation

“…We were interested in determining the prevalence of bursal hypertrophy within the plantar forefoot region and therefore scanned the forefoot using a systematic protocol moving from the medial to the lateral aspect of the foot, scanning in both the transverse and longitudinal planes from the plantar surface of the foot. US‐detected bursae were identified from the plantar aspect of the forefoot according to previous definitions (13, 16, 24–26) (Figures 1 and 2). Following preliminary comparisons with higher‐resolution US technology (Philips HDI 5000 System; Royal Philips Electronics), our US imaging protocol was confirmed as the best approach for detection of plantar forefoot bursae (22).…”