Bursitis

Bursitis

The body has a number of mechanisms that help cushion and lubricate joints and bones. One of these is called the bursa, a fluid-filled sac that separates, cushions and lubricates in order to reduce the friction between two surfaces that move in opposing directions.  These surfaces are mostly muscles and tendons that glide over bony structures or glide between bones, especially in the joint areas. In the process of protecting these structures from becoming inflamed, the bursa itself can become inflamed--a condition called “bursitis.”

In the foot, there is only one naturally-occurring bursa. It is located between the Achilles tendon and the heel bone (calcaneus). This bursa protects the Achilles tendon from the pressure of the heel bone pressing against it during walking and running. This is the most common area of bursitis in the feet, also known as retrocalcaneal bursitis.

The body also creates bursal sacs in response to damage. In the feet, these areas include the following:

• the first metatarsal phalangeal joint (the base of the big toe, often associated with a bunion)
• the base of the second metatarsal phalangeal joint (the base of the second toe)
• the base of the fifth toe (often associated with a bunionette)
• the bottom of the heel and the bottom of the forefoot
• the ankle area

Causes

The feet are subjected to ongoing stress when walking and doing other activities on unfriendly surfaces such as concrete, asphalt, and hard floors. This foot stress is often exacerbated by poorly designed and fitted shoes. Pressure, impact and shear force can damage the feet over time. The body’s response to this damage is to create a bursa that protects weight-bearing and joint areas. Many times, the bursa itself becomes inflamed.

A common condition that can cause bursitis in the heel area is Haglund’s deformity, a bony enlargement on the back of the heel. In this condition, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes, especially the rigid heel counters of high heel pumps. Haglund’s deformity is often called “pump bump,” and it generally affects women.

Other causes of bursitis include a direct blow or other injury to a foot joint, acute or chronic infection, arthritis and gout.  Risk of bursitis increases with participation in the following:

• competitive athletics, particularly contact sports
• a previous history of bursitis in any joint
• exposure to cold weather
• poor conditioning
• inadequate warming up and stretching

Prevention and Treatment

To reduce excessive rubbing or stress in the Achilles area, wear properly designed and fitted shoes or boots that provide cushioning in the heel counter.  Sufficient width in the toe box helps ensure minimal compression, helps reduce the risk of rubbing of the first and fifth metatarsal joints, and helps diminish the possibility of bursitis in the toe areas.

To alleviate the pain of bursitis, anti-inflammatory medication may be required. Talk with your Podiatrist about you options. Icing the area also may reduce symptoms. Physical therapy is also an option.

If these conservative measures fail, your Podiatrist at Advanced Foot & Ankle Center may recommend cortisone injections or draining the bursal sac--but if the root cause of the bursitis is not eliminated, it can recur even after these measures are taken.

Medical Considerations

Although bursitis can be painful, it is not usually a serious condition. Redness and swollen areas associated with bursitis can, however, indicate infection and should be addressed by a podiatrist as a precautionary measure. Always talk to your Podiatrist if you have soreness, pain, redness, swelling or other indications of problems in any area of the foot that persist for more than a few days.