Tips and Tricks for Forefoot Bursitis or Intermetatarsal Bursitis

It’s apparently rare (ish) to get forefoot bursitis. If you look for information or treatment options about bursitis, most “foot bursitis” is about heel bursitis. If not foot, then it’s knee, elbow, or hip bursitis. All sounds unfun. But what’s also unfun is actual forefoot bursitis, which is usually intermetatarsal bursitis.

Flash back to when I broke my fifth toe on my right foot about 7 weeks ago. I cried, hard, after I broke it. Not only because it hurt, but also because I knew how hard it was to return to walking after I broke my ankle 3.5 years ago. And I knew from that experience that returning to walking would come not only with the standard trials and tribulations of injury recovery but also a risk of redeveloping intermetatarsal bursitis in not one but two parts of my foot. It was brutal, and I had to take another 6 weeks off of running last time after I discovered it. So when I broke my toe, I wasn’t looking forward to the recovery process, as I knew there was a greater than zero chance that I’d have to face bursitis again as well.

And sure enough, a week or so after I returned to full weight bearing and was working on extending my walking, I felt the no good terrible horrible pain in my forefoot that is intermetatarsal bursitis. Same spot as last time. And worse, because it actually was in the second spot, too, between my first and second toes as well as the third and fourth. Last time I primarily felt it in the third/fourth area of my foot while an MRI identified that I also had it between one/two. This time, I felt it in both places, and there was no winning and no reduction in pain no matter how I set my foot on the ground. Ahhh!

But I learned my lesson from last time, I think. I very quickly started trying to reduce the pain by changing the shoes I was wearing (didn’t help) and the way I was walking (didn’t help). I had been nearly to the stage of my recovery process where I could try to start running again, but I knew if I couldn’t even walk barefoot across a hard floor in the house that it likely wasn’t going to be bearable to run on my foot. And it wasn’t.

I gnashed my teeth and did a bunch of research, looking for solutions. I found heaps of information on every other type of bursitis, but very little on intermetatarsal bursitis. Harumph. (Thus, I’m leaving this post as breadcrumbs for anyone else in the future, and maybe for me, too, so I remember what works for next time if I ever have to deal with it yet again.)

Last time, I tried a metatarsal pad in a little sleeve for my foot, which didn’t help. Nothing helped except for trying to stay off my foot as much as possible. I tried a different insole for my shoe with a steel tip, to help reduce the force in the forefoot area as my foot hit the ground. That helped minimize the pain somewhat to make short daily walks tolerable. Otherwise, I waited 6+ weeks for the pain to go away.

This time, I was really hoping to not have another 6 weeks before I could run, since I was and am again training for an ultramarathon. Breaking my toe put a 6+ week snafu on my plans for the fall; I was hoping not to have to give up on my fall ultra plans completely.

Most of the research on bursitis in general suggests trying to reduce inflammation, because that’s what bursitis is: inflammation of bursa. Oral NSAIDs like ibuprofen may or may not help. In my case this time, I was already taking oral NSAIDs for other reasons and it didn’t seem to do anything in regards to bursitis pain. But this reminded me to try NSAID gel (such as this, a generic option, or there are brand name kinds that do the same thing) on my forefoot. It does seem to help a little bit with pain in the hours following using it. The challenge is putting it on and sitting to let it dry so it can get into the skin and start working.

But since I was so desperate, I dug through my cabinet of ankle braces and other foot-related gear and found the metatarsal sleeve pad that I didn’t use last time because it didn’t work. But lo and behold, this time it DID work! I tentatively walked around the house barefoot, amazed that it completely eliminated the bursitis pain in both spots of my foot, and enabled me to walk over my foot without having to compensate by putting too much pressure onto my recently broken (but now mostly healed) toe.

The metatarsal pad sleeve (similar to this one) is a small pad inside a sleeve that sits and takes weight and distributes it to different areas of your foot, rather than the same bursitis areas of your foot getting the full force of your step. I am not sure why it didn’t work well for me last time, but this time it’s the closest thing to magic that I’ve ever experienced. Usually, when something hurts, a solution might reduce pain, but there have been few things that completely eliminate pain during use like this does. (Note that I still have bursitis and will likely still have it for weeks, so I still have to wear flip-flops or the foot sleeve around the house to make sure my foot doesn’t hurt.)

Because it’s a fabric sleeve, it does take up space in my shoe, and I’ve found that even with a larger size shoe it’s uncomfortable to wear a sock when I’m wearing the sleeve on that foot. It feels weird, but the metatarsal sleeve and otherwise being barefoot inside my normal-size shoe works well. So well that I can get back to my running, even with bursitis, which is awesome.

The other trick that I learned last time is to leave a squishy or memory foam flip-flop by my shower. (Here’s an example. Although they’re harder to find, I’ve also found a random store brand memory foam flip-flop option that works well.) Some days standing in the shower hurts due to the pressure on the bottom of my foot, other days it doesn’t. Setting my right foot, the one with the intermetatarsal bursitis, on top of the flip-flop (or wearing it) helps distribute the weight in a way that doesn’t hurt the bursitis as much on the hard shower floor. (If you try this, I’d be sure to be careful getting in and out of the shower with it – I usually set it in the shower and step on it once I’m already in, and that way I step out of the shower without a wet flip-flop to worry about slipping with.)

So TLDR:

  • Intermetatarsal bursitis or forefoot bursitis is a thing.
  • It hurts, a lot. If you have it, I’m sorry.
  • It takes weeks for it to fix itself usually. Argh
  • Normal anti-inflammation things might help: ice, oral NSAID, NSAID gel, heat, etc.
  • Try to rest/not do things that make it hurt (if at all possible).
  • If you have intermetatarsal bursitis, look at getting a metatarsal pad to put in your shoe, or get a metatarsal pad sleeve that you can wear with any shoes, including when barefoot or in sandals.
  • Set a squishy or memory foam flip-flop by the shower to stand on if your foot hurts standing in the shower, or wear flip-flops in the shower.

2 thoughts on “Tips and Tricks for Forefoot Bursitis or Intermetatarsal Bursitis

  1. Cannot thank you enough for taking the time to share your story. I’ve been dealing with forefoot bursitis for several weeks now while also trying to train for a marathon in November. The podiatrist wanted me in a boot with no exceptions & no plans to run for a minimum 4 weeks. The orthopedist told me I could lose the boot if I wore proper shoes w/ orthotics as well as enlisted rest, ice, elevation & NSAIDs. He also gave me a round of prednisone which worked like a dream for about a week. At any rate, I’m still hoping to pull off the race in 6 weeks, but it isn’t getting any easier & I’m now worried about long-term repercussions. It is very hard to find forefoot specific info.
    PS – My OOFOS flip-flops have been the only shoes outside of my running shoes that provide significant relief. And I actually leave a pair right outside the shower as well :-)

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