You take off your shoe and feel the urge to rub the ball of your foot. Sometimes you feel like there’s a small foreign object under the tips of your toes. Sometimes two toes splay out a little, and you don’t know why. Long walks become painful, high heels are out of the question, and you may have already heard about Morton’s neuroma—even if the story doesn’t quite add up.

This pain has a lesser-known name: intercapito-metatarsal bursitis. It is a very real irritation of a small bursa located between the bones of the forefoot. A review published in 2023, which examined 28 studies, concluded that it should be considered a legitimate cause of forefoot pain, even in people who do not have rheumatism. A more recent study, conducted in 2025 on patients with pain in the space between the toes, even found this bursitis more often than a neuroma on MRI scans.

At the office, this is an issue we can address. But not with a promise of a cure in a single session: the studies don’t say that, and neither will I. Through a thorough examination, gentle treatments, footwear advice that can truly make a difference in your day, and, if necessary, a referral to a doctor, podiatrist, or imaging specialist. This article explains what you can expect—and what you shouldn’t expect.

Dorsal view of the forefoot showing the inflammatory bursa between the metatarsal heads, above the deep transverse ligament

The irritated bursa is located between the heads of the metatarsal bones, above the ligament that connects them. The nearby nerve may be irritated, though this does not necessarily mean it is a neuroma.

Between the heads of the metatarsals—the long bones that end at the toes—there are small bursae. Their function is simple: to reduce friction between the bone, a ligament, and the bundle of nerves and blood vessels that passes through that space. As long as they remain thin, you won’t feel them. In fact, a fluid collection measuring 3 millimeters or less is considered normal on imaging studies.

Bursitis is when the bursa fills with fluid, thickens, and becomes painful. It most often occurs between the second and third toes, and sometimes between the third and fourth. The space is narrow. A shoe that’s too tight, a heel that shifts weight forward, a long walk, or resuming running too quickly: the bursa is subjected to repeated compression. It can also become irritated due to inflammatory arthritis, such as polyarthritis. In this case, the primary treatment is not manual therapy, and it’s important to recognize this early on.

The term “intercapito-metatarsal” simply means “between the heads of the metatarsals.” It is also referred to as intermetatarsal bursitis. This is not the same as pain under a metatarsal head caused by a plantar corn: in that case, the pressure is on the bone itself, not in the space between two bones. The distinction is important because the type of cushioning you place in your shoe is different.

No one can make a diagnosis for you based on an article. However, certain symptoms occur often enough to warrant a doctor’s visit, rather than waiting for “it to go away with rest.”

Pain upon pressure in this area is common. Tingling in the toes may occur because the nerve runs right next to the bursa. If the tingling is sharp, electric-like, and radiates to two adjacent toes, Morton’s neuroma should also be considered. The two conditions are similar, and they can even coexist.

Morton's neuroma is not a tumor. It is a fibrous thickening of the nerve that runs between the toes, often in the third interdigital space. Bursitis, on the other hand, is a fluid-filled sac. The pain can feel the same: a burning sensation, a feeling of a foreign object, and relief when removing the shoe.

A few distinguishing features can be helpful, though they do not replace a physical examination. A neuroma is more likely to produce an electric shock-like sensation and a painful click when pressure is applied to the forefoot—known as the “Mulder click.” Bursitis, on the other hand, typically causes pain on pressure, sometimes accompanied by toe spreading, and is associated with fewer sensory disturbances. On ultrasound, the bursa flattens under the probe; the neuroma, a firmer mass, does not flatten. On MRI, the bursa has a fluid signal and a rim that is more intense at the periphery.

The 2025 prospective study is worth noting, even though it involved only 26 patients with pain. On MRI, 53.8% had bursitis and 19.2% had a neuroma. Ultrasound, in the same group, detected bursitis in nearly every case and no neuromas. In other words: a report that mentions bursitis isn’t always conclusive, and neither is one that mentions Morton’s neuroma. If your pain persists, you should discuss the imaging results with your doctor. In my practice, I don’t “guess” what the images mean when the picture isn’t clear.

Osteopathy has a role to play in treating mechanical pain in the forefoot. It should not be the first line of treatment if there is an underlying cause. Before making an appointment—or during the first session if these signs appear—a medical evaluation is necessary in the following cases.

In these situations, seeing a doctor isn't a waste of time. It's what keeps you from wasting weeks on the wrong treatment.

As of today, there are no studies that specifically measure the effect of osteopathy on this type of bursitis. I’d rather be clear about this. What we do know is the mechanism: a bursa that is repeatedly compressed, often in a forefoot that is already under uneven pressure, sometimes accompanied by a stiff calf that restricts ankle movement, or a shoe that constricts the space. The role of the practice is to reduce these stresses, not to “empty” the bursa with the hands.

We review the history: when did it start, in which shoe, following what change in walking, running, or standing work, with or without tingling, and whether or not the toes are splayed. We examine the foot while bearing weight. We gently palpate each space, without applying pressure. We test the flexibility of the metatarsal heads—with the ankle and knee both straight and bent—and the stability of the second toe. The knee, hip, or pelvis are only examined if they clearly alter the way you place your foot. There is no evidence that a pelvic restriction “causes” bursitis. Sometimes, however, a person’s walking pattern consistently puts stress on the same spot.

If the pain has already lasted for several weeks, if your toes are splayed, or if no one has yet examined your foot with imaging, I may suggest that you talk to your doctor about getting an ultrasound. This doesn’t mean the session was a failure. It’s often what prevents us from mistaking a thickened nerve for a simple irritation—or vice versa.

In cases of inflammatory swelling, rapid manipulations of the forefoot are not warranted. They may even aggravate an already irritated joint. Effective treatment involves slow, deliberate movements.

The real key—the one that clinical guidelines prioritize—is still the shoe itself: a wide toe box, a low heel, and a forefoot that doesn’t compress the foot. Then, very often, an insole made by a podiatrist, with a small pad placed just behind the metatarsal heads to create more space. The placement is delicate: a pad that’s too far forward increases pressure instead of relieving it. I don’t make this insole. I’ll explain why it makes sense, and at the next appointment, I’ll check to make sure it’s being worn in a shoe deep enough to accommodate it.

In practice, two to four sessions over four to six weeks are enough to determine whether this approach is helping you. The key indicator isn’t just “I’m in less pain on the treatment table.” It’s the distance you can walk without using your fingers to feel for space, and your ability to put your shoes back on without resorting to avoidance strategies. If there’s no improvement, we stop the local treatments and move on.

Tecartherapy, or diathermy using capacitive and resistive electrical transfer, is a device-based treatment. A movable electrode delivers a gentle radiofrequency, typically around 500 kilohertz. The goal is to locally increase temperature and microcirculation to relieve pain in a specific area. There are two modes: capacitive, which acts more superficially, and resistive, which acts more deeply.

Reviews published since 2020 often report a reduction in pain associated with musculoskeletal conditions, particularly in the back and knees, especially when TECAR therapy is added to active treatment. A 2022 meta-analysis describes a reduction in pain at four and eight weeks, with results varying widely from one study to another. A 2026 review focusing on the lower extremities, involving 19 trials and 911 participants, found a benefit of approximately two points out of ten in favor of this type of radiofrequency therapy, again with widely varying protocols. None of these studies specifically addressed bursitis between the toes.

In my practice, I can therefore recommend it as a supplementary treatment once a diagnosis of mechanical irritation has been confirmed—but never as a substitute for a wider shoe or an insole. The treatment must remain comfortable and should not cause any burning sensation. If there is no improvement in gait after one to three applications, we do not continue the treatment. It is not recommended if the skin is damaged, if an infection is suspected, or if you have a pacemaker: the manufacturer’s precautions apply. I’m telling you this in advance so that you can make an informed decision.

K-tape is that colorful elastic tape you see athletes wearing. When applied to the foot, serious studies have focused mainly on heel pain and plantar fasciitis, showing modest and, above all, short-lived benefits. There are no trials on intercapito-metatarsal bursitis. The only relevant study is a small 2002 series on Morton’s neuroma: the authors themselves described it as a finding that needed to be confirmed, not as proof.

Rigid tape, such as Low-Dye tape, offers a more precisely measured mechanical benefit: it can reduce pressure under the forefoot by limiting the collapse of the arch. The elastic band, on the other hand, provides little support. If I use it, it’s at the end of a session, without applying tension to the painful area, for 24 to 72 hours, as a way to remind the foot to rest. A bandage that’s too tight in an already narrow shoe would have the opposite effect of what we’re aiming for. Remove it at the first sign of chafing, the first blister, or if the pain increases. Avoid using it if you have sensitive skin or diabetes.

Choosing the right shoes is no small matter. It’s often the most worthwhile decision you can make. A wide toe box, a heel that doesn’t constantly tip you forward, and enough depth to accommodate an insole. High heels and pointed toes block off the exact space where your wallet sits.

The insole with retrocapital support—a small metatarsal dome positioned behind the metatarsal heads—is designed to slightly spread the bones apart and relieve pressure in the space. In cases of neuroma, a 2005 study found that 63% of patients experienced complete or partial relief at one year with proper footwear and orthotics. This figure does not apply to isolated bursitis. It merely shows that properly managed conservative treatment is worth trying before considering an injection or surgery.

If that is not enough and the imaging confirms a bursa, the doctor may recommend an ultrasound-guided cortisone injection. Studies specific to this type of bursitis date back a long time: in 1982, 28 out of 50 patients experienced complete relief after the injection; in 2007, 28% of a mixed group that included neuromas. The effect of a cortisone injection generally lasts from a few weeks to a few months. If repeated too often, it can thin the fat pad under the foot. This is not a trivial procedure, and it is not up to me to decide whether to perform it.

Surgery remains rare. It is considered only after a thorough course of medical treatment has failed—not after just two sessions. The procedure involves removing the bursa, sometimes combined with a procedure on the nerve if a neuroma is present, or with a correction of the foot’s support if the shape of the forefoot is contributing to the problem. The decision rests with the foot surgeon.

Here is the framework I suggest when the presentation resembles mechanical bursitis. This is not a study protocol. It’s a way to avoid scheduling one appointment after another without knowing why.

Many people put up with this discomfort for months, simply switching to a different pair of shoes or telling themselves it’s just a sign of aging. Others keep using improperly fitted insoles or shoes that are too tight, without anyone ever checking whether two toes are splayed or if the second metatarsal is unstable. The purpose of the consultation is to sort these issues out: determining what can be treated by relieving pressure, what requires imaging, and what needs to be referred to another specialist.

You’re welcome to come if you recognize the sensation of a foreign object in your foot, pain between two toes that eases when you’re barefoot, or a diagnosis of a neuroma that you’re not entirely convinced by. Come wearing your everyday shoes, not just the “special” pair you’ve saved for this appointment. If you have an ultrasound or MRI, bring it with you. The session is designed to help me understand your foot—not to apply a one-size-fits-all technique.

I can’t guarantee that the swelling will go away. I can, however, tell you clearly whether osteopathy is right for your situation, what we’ll try, how long it will take to see results, and who to turn to if it isn’t enough. It’s often this comprehensive approach—rather than a single treatment—that helps you regain a comfortable gait.

Larsen et al., Diagnostics, 2023. A review of 28 studies on intermetatarsal bursitis: a true cause of metatarsalgia, a sign of splayed toes, fluid measuring 3 mm or less is often physiological, and treatments remain understudied.

A 2025 prospective study comparing MRI and ultrasound in 26 patients with pain: bursitis was more common than neuroma on MRI, but the two were difficult to distinguish using ultrasound alone.

Radiopaedia, entry revised in 2025, and imaging review of metatarsalgia, 2025: fluid-filled appearance, located between the heads, possible association with a neuroma and a lesion of the plantar plate.

French-language practice guidelines: wide-fitting shoes, low heels, space-opening insoles, and ultrasound-guided injection only thereafter.

Reviews on Tecar therapy, 2020, 2022, and 2026: possible analgesic effect for other musculoskeletal pain conditions; no specific studies on this type of bursitis.

Review of taping techniques, 2020, and a limited series from 2002 on neuromas: K-tape is not a proven treatment for intercapito-metatarsal bursitis.