Intermetatarsal bursae

The intermetatarsal bursae are synovial-lined sacs located in the forefoot within the intermetatarsal spaces between the metatarsal heads. Each bursa is situated superior (dorsal) to the deep transverse metatarsal ligament (DTML), extending distally in the second and third intermetatarsal spaces, often closely abutting the neurovascular bundles. In contrast, in the first and fourth intermetatarsal spaces, the bursae do not extend beyond the DTML. The bursa in the first intermetatarsal space is unique, following the course of the adductor hallucis tendon and resembling a tendon sheath rather than a typical bursal sac. Histologically, the bursal wall consists of a single layer of attenuated synovial cells, confirming its synovial nature.