Bursitis is a common condition that can occur in the knees, elbows, and heels. When bursitis occurs in the heel, it is the result of one or two bursae near the Achilles tendon becoming swollen and inflamed.
Bursitis in the feet can be caused by trauma or by repetitive use, or it may be associated with another condition, such as gout or arthritis. In many cases, bursitis can be treated with home remedies such as ice packs, rest, and anti-inflammatory medications.
In some cases, especially when bursitis becomes chronic, treatment may include physical therapy or cortisone injections into the bursa. A bursa that has become infected will require treatment with antibiotics.
What Is Bursitis?
Bursitis is the inflammation of one or more bursae. Bursae are fluid-filled sacks located in various points around the body. Their primary function is to reduce friction between the tendons and the joints, and sometimes the skin.
Bursae are located in the shoulders, the elbows, the hips, and the knees. In the foot, bursae are located both anteriorly and posteriorly to the Achilles tendon. Bursae can become inflamed and painful.
In the feet, an inflamed bursa can be caused from overuse, such as after a period of repetitive motion, or associated with another condition such as arthritis.
Bursitis can become chronic. Chronic bursitis can lead to complications, such as a limited range of motion or even loss of tendon strength and tendon damage.
What Are the Various Types of Bursitis In the Foot?
Anterior Achilles tendon bursitis: The Achilles tendon runs between the calf and the heel, and is the largest tendon in the body. When the Achilles tendon is overused or compromised by disease, the bursa located at the point where the tendon attaches to the heel may become inflamed.
Posterior Achilles tendon bursitis: This type of bursitis affects the bursa that is located between the skin and the Achilles tendon, and is more common in young women. It often occurs because a shoe is rubbing against the heel, resulting in an inflammation of the bursa located there and a bony growth of the superior-lateral aspect of the heel; this growth is known as a Haglund’s Deformity.
What Are the Symptoms of Bursitis in the Foot?
The symptoms of bursitis oin the foot can include:
- Ache or stiffness in the heel
- An increase in pain with pressure on the heel
- Warmth, whether infection is present or not
In cases in which the bursa has become infected, symptoms may also include fever, and the skin in the area of the bursa may be hot to the touch.
How Does Bursitis in the Foot Develop?
The risk factors for bursitis in the foot include age, the presence of other diseases and conditions, and overuse of the joints in the feet.
Age: People of any age can develop bursitis, but the risk increases with age.
Other diseases and conditions: People who have gout, diabetes, tendonitis, thyroid disease, or arthritis (especially rheumatoid arthritis) are at an increased risk of developing bursitis.
Infection: An infected bursa may occur if the skin around the bursa has been injured or cracked, allowing a bacterial agent to invade. This is especially a concern for people whose immune systems are compromised or depressed, such as those who have diabetes or who are undergoing chemotherapy.
Physical condition: Those who are in poor physical condition or who are overweight tend to develop bursitis in the foot more often.
Joint overuse or injury: Repetitive motion and pressure on a joint can result in bursitis. Bursitis is more common in people who have jobs such as laying carpet or tile, athletes such as ice skaters, and in those who practice hobbies such as gardening. A trauma to the area of the bursa can also result in symptoms of bursitis. In most cases, this type of bursitis develops over time.
Diagnosing Bursitis in the Foot – What to Expect
When first examining a patient who appears to have symptoms of bursitis in the foot, a podiatrist will want to rule out other potential causes.
The symptoms of bursitis are not very specific, and can potentially be caused by other conditions, such as a fracture. An x-ray of the foot may show a swollen bursa, but it can also help by showing that there is no other condition present, such as bone spurring or entheses (calcification) of the tendon.
In most cases, bursitis in the foot is diagnosed without any imaging studies, but magnetic resonance imaging (MRI) scans may be used if a physical exam is insufficient to determine the cause of symptoms or the degree of associated tendon pathology that may be present.
Some lab tests may also be conducted when bursitis is suspected. If there is inflammation, blood tests may be performed to determine the extent of the inflammation and to check for an associated condition, such as rheumatoid arthritis.
In some cases, fluid from the inflamed bursa might be extracted with a syringe and sent out for analysis. This test, called aspiration, can help determine the cause of the bursitis.
How Is Bursitis in the Foot Treated?
In many cases, bursitis in the foot can be treated at home with methods such as:
- R.I.C.E: Rest, Ice, Compression, and Elevation of the affected foot can help reduce inflammation and pain.
- Anti-inflammatories: Over-the-counter medications such as ibuprofen or aspirin can be used to treat the pain and the inflammation.
- Splinting or bracing: A splint or a brace for the heel may help to take the pressure off the heel and the affected bursa.
- Resting: Aside from resting when the bursitis is acute, taking rests during any activity that aggravates the bursitis can also help.
In cases in which bursitis is advanced, or is not responding to home treatment methods, other treatments may be tried, including:
- Cortisone injections: An injection of cortisone into the heel bursa sac can help to quickly reduce the inflammation in the bursa. This treatment is often performed in a podiatrist’s office.
- Physical therapy: When the initial inflammation of the bursitis has been quieted, physical therapy may be prescribed. Therapy can help strengthen the muscles involved to prevent the bursitis from recurring. Therapy can also help the patient learn how to avoid overusing the affected tendon.
If a bursa becomes infected, the resulting condition is called septic bursitis and will need specialized treatment. The fluid inside the bursa contains infection-causing bacteria, and will therefore need to be drained.
Antibiotics can then be administered to treat the infection. In some cases, the infected bursa may need to be removed surgically, an operation known as a bursectomy.