Intermetatarsal bursitis as first disease manifestation in different rheumatological disorders

NewsBot · Jul 21, 2019

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Intermetatarsal bursitis as first disease manifestation in different rheumatological disorders and related MR-imaging findings.
Albtoush OM et al
Rheumatol Int. 2019 Jul 18. doi: 10.1007/s00296-019-04381-x

Metatarsalgia defined as pain at the plantar aspect of the forefoot. Intermetatarsal bursitis is considered one potential soft-tissue cause of metatarsalgia that is presumably under-estimated, under-investigated, and, consequently, often misdiagnosed. To assess the role of MRI in the elucidation of the cause of metatarsalgia in patients with different autoimmune disorders presenting primarily with this symptom and to present the accompanying clinical and radiological findings of intermetatarsal bursitis. Retrospective evaluation of the medical records of patients with different rheumatological conditions claiming primarily of pedal pains suggests metatarsalgia and who underwent, therefore, all magnetic resonance imaging between March 2010 and April 2018. Of them, six patients fulfilled these criteria and were diagnosed subsequently with intermetatarsal bursitis. Several underlying autoimmune conditions were diagnosed. All patients were clinically assessed by the squeeze test and radiologically investigated with MRI; three patients underwent additional sonography. All patients presented intermetatarsal bursitis as first disease manifestation. The number of involved bursae ranged from one to three on one side. The main MR findings were distension of the intermetatarsal bursa with increased signal intensity on T2-weighted and post-contrast fat saturation T1-weighted images. Most frequent locations were the second and third intermetatarsal spaces. The size of the intermetatarsal bursitis and its plantar extension were correlated in all patients. Intermetatarsal bursitis can potentially be the first manifestation of different rheumatological diseases. Awareness of this potential association as well as cognizance of its imaging findings can help for making a more accurate and prompt earlier diagnosis of the underlying disease changing also the therapeutic approach.
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NewsBot · Jan 20, 2022

Which inflamed tissues explain a positive metatarsophalangeal squeeze test? A large imaging study to clarify a common diagnostic procedure
Bastiaan T van Dijk, Yousra J Dakkak, Doortje K Krijbolder, D van Zeben, Ilja Tchetverikov, Monique Reijnierse, Annette H M van der Helm-van Mil
Rheumatology, 13 January 2022

The squeeze-test of metatarsophalangeal (MTP-)joints is frequently used, because it is easy and cheap. It is traditionally perceived as a test for synovitis. Besides classic intra-articular synovitis, also tenosynovitis and intermetatarsal bursitis (IMB) represent synovial inflammation, albeit juxta-articularly located. Both are frequently present in RA and occasionally in other arthritides. Therefore, we hypothesised that tenosynovitis and IMB contribute to a positive MTP-squeeze-test.

Methods
A cross-sectional study-design was used. 192 early arthritis patients and 693 clinically suspect arthralgia (CSA) patients underwent the MTP-squeeze-test and forefoot-MRI at first presentation. MRI-measurements in age-matched healthy controls were used to define positivity for synovitis, tenosynovitis and IMB. Logistic regression was used.

Results
In early arthritis patients synovitis (OR 4.8 (95%CI 2.5–9.5)), tenosynovitis (2.4 (1.2–4.7)) and IMB (1.7 (1.2–2.6)) associated with MTP-squeeze-test positivity. Synovitis (3.2 (1.4–7.2)) and IMB (3.9 (1.7–8.8)) remained associated in multivariable analyses. Of patients with a positive MTP-squeeze-test, 79% had synovitis or IMB: 12% synovitis, 15% IMB and 52% both synovitis and IMB. In CSA-patients, subclinical synovitis (3.0 (2.0–4.7)), tenosynovitis (2.7 (1.6–4.6)) and IMB (1.7(1.2–2.6)) associated with MTP-squeeze-test positivity, with the strongest association for synovitis in multivariable analysis. Of positive MTP-squeeze-tests, 39% had synovitis or IMB: 10% synovitis, 15% IMB and 13% both synovitis and IMB.

Conclusion
Besides synovitis, IMB contributes to pain upon compression in early arthritis, presumably due to its location between MTP-joints. This is the first evidence showing that MTP-squeeze-test positivity is not only explained by intra- but also juxta-articular inflammation.
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NewsBot · Mar 8, 2022

Diagnostic and Therapeutic Challenge of Metatarsalgia in a Patient With Rheumatoid Arthritis
João N Malta et al
Cureus. 2022 Jan 30;14(1):e21751

A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints, associated with swelling and morning stiffness (mean time: four hours). Physical examination evidenced a tender and soft nodularity in the third intermetatarsal space, along with sharp pain, consistent with Morton's neuroma. Foot ultrasound suggested Morton's neuroma, but not excluding the possibility of rheumatoid arthritis involvement. Foot magnetic resonance imaging suggested the possibility of extensive synovitis of the third metatarsophalangeal joint, but not excluding the coexistence of Morton's neuroma because of the mass effect. Finally, the patient underwent an ultrasound-guided needle biopsy of the nodule, which confirmed metatarsophalangeal joint synovitis. The foot is a common location of rheumatoid arthritis manifestation, and metatarsophalangeal joint synovitis can mimic Morton's neuroma. After a definite diagnosis, the patient recovered lower limb functional impairment after introducing adalimumab and a rehabilitation program. This case highlights the importance of an accurate differential diagnosis, pharmacological rheumatoid arthritis control, and physical medicine and rehabilitation programs to optimal clinical and functional improvement.
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NewsBot · Apr 4, 2022

Intermetatarsal bursitis in the foot as the initial manifestation of rheumatoid arthritis

NewsBot · Jan 27, 2023

This was just registered:
Intermetatarsal Bursitis in Patients With Rheumatoid Arthritis

The aim of the study is to investigate the incidence and clinical implications of intermetatarsal bursitis (IMB) in patients with rheumatoid arthritis (RA).

The hypothesis is that IMB is a cause of pain in patients with RA.
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NewsBot · Nov 13, 2023

Intermetatarsal Bursitis: A case report
Km. Bhumika et al
IJPDD: Number 1, Vol. 1, 2023

Bursae are normally empty areas that are not filled with synovial fluid when they are in their natural form. Bursae are also referred to as bursa sacs. Bursae are sac-like structures that are sometimes seen in the body's joints. When synovial fluid begins to collect in the bursa, this is a symptom that a mechanical or inflammatory response has taken place in the region. The reaction might have been caused by friction or inflammation. Patients who are afflicted with rheumatoid arthritis often struggle with issues related to their inter-capito-metatarsal bursopathies (RA). The most common symptom is known as metatarsalgia, and it is characterised as a feeling that there is a "stone in the shoe." This condition may be very painful. It seems that the diagnosis is correct, at least according to the results of the magnetic resonance imaging and the ultrasound (MRI).
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NewsBot · Dec 26, 2023

Separating toes due to intermetatarsal bursitis in rheumatoid arthritis

Intermetatarsal bursitis as first disease manifestation in different rheumatological disorders

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Intermetatarsal bursitis as first disease manifestation in different rheumatological disorders

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Intermetatarsal bursitis

Orthotic causing Intermetatarsal Bursitis?

Second intermetatarsal space syndrome

Anatomy of the Plantar Intermetatarsal Tunnel

Good technique for bunion kinesio taping (intermetatarsal angle)?

HELP!!! Multiple Intermetatarsal Bursiitis not responding to treatment.

Are Podiatrists in NZ allowed to diagnose Mortons Neuroma via intermetatarsal injection

Share This Page

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