Bursa Lesions on Toes | Causes, Treatment, and Recovery

What are bursa lesions?

A bursa is a small fluid-filled sac that cushions pressure points between bone, skin, and soft tissues. When irritated or inflamed, it can form a painful swelling over the toe joints.

These swellings are often confused with corns or soft corns:

• Hard corns are patches of dense skin caused by pressure.
• Soft corns develop between toes in moist areas.
• Bursa lesions are deeper, fluid-filled swellings caused by friction over bone or joint prominences.

Why do they occur?

Bursa lesions form where the skin is constantly rubbed or compressed against footwear. This usually happens in:

• Long toes, where the knuckle pushes against shoe material.
• Toe deformities (hammer toes, bunions).
• Poorly fitting shoes, especially narrow or high-heeled.
• Repeated friction and pressure over time.

Why excision alone is often not enough?

A simple bursa removal may provide short-term relief, but in many cases the swelling comes back. The reason is structural:

• If a toe is long, the pressure point against the shoe remains.
• If a toe joint is deformed, the prominence continues to rub.
• Closing the wound after excision can be difficult when there isn’t enough skin to cover the area.
• This is why toe shortening and/or joint fusion is often combined with bursa excision.

Toe shortening – why it’s needed

Toe shortening surgery is performed when a toe is excessively long and prone to rubbing. By shortening the toe:

• The bony prominence is reduced, removing the source of friction.
• Skin can be closed more easily after bursa removal.
• Shoe fit and cosmetic appearance improve.
• The risk of the bursa coming back is greatly reduced.

In many cases, bursa excision + toe shortening is the most effective solution for long-term relief.

How bursa surgery differs from corn removal

It is important to distinguish between the two:

• Corn removal by a podiatrist is a simple skin procedure, paring away thickened skin. Relief is temporary.
• Bursa lesion surgery by a foot surgeon involves making an incision on the top of the toe, removing the bursa and lesion, and stitching the skin.
• If the toe is long or deformed, toe shortening or joint fusion is performed at the same time.

Post-operative recovery

• Day case procedure under local anaesthetic or sedation.
• Walking immediately in a protective shoe.
• Stitches removed after 2 weeks.
• Bone healing takes 6–8 weeks.
• Swelling may last 3–4 months before fully resolving.
• Return to normal footwear usually at 6–8 weeks.

Risks of surgery

As with any surgery, risks include:

• Infection or delayed healing.
• Recurrence if the toe length/deformity isn’t fully addressed.
• Residual swelling or stiffness.
• Over- or under-correction of toe length or position.
• Scarring, more visible in darker skin types.
• Rarely, nerve irritation or delayed bone healing.

Key takeaways

• Bursa lesions are often mistaken for corns but are caused by deeper bone and joint pressure.
• Excision alone often fails if toes are long or deformed.
• Toe shortening and/or joint fusion with bursa removal offers a lasting solution.
• Surgery is safe, recovery straightforward, and patients walk immediately in a protective shoe.
• Healing takes 6–8 weeks for bone, with swelling improving over 3–4 months.

FAQ

Is a bursa the same as a corn?

No. Corns are thickened skin, while a bursa is a fluid-filled sac under the skin. They may feel similar but are different conditions.

Can’t my podiatrist just cut this out like a corn?

Podiatrists can pare down corns, but this doesn’t remove a bursa. Bursa excision is a surgical procedure performed by a foot surgeon.

Why do I need toe shortening as well?

If your toe is long, the pressure point remains even after bursa removal. Shortening reduces rubbing, makes skin closure easier, and prevents the lesion from coming back.

What type of anaesthetic is used?

Most cases are done as a day case under local anaesthetic (foot numbed). Some patients choose sedation for extra comfort.

How long before I can walk again?

You can walk immediately in a protective surgical shoe. Normal shoes are usually possible within 6–8 weeks.

How long does the swelling last?

The bone heals in 6–8 weeks, but swelling can take 3–4 months to fully settle.

What are the risks?

Infection, scarring, stiffness, recurrence, or over/under correction are possible but uncommon. Your surgeon will discuss your individual risks.

Will the surgery leave a scar?

A small incision is made on top of the toe. Scars usually fade, though in darker skin types they may be more visible.