How To Treat Bursitis Of The Foot

Overview
In your heel, there is a sac filled with fluid known as a bursa. It is located under your Achilles tendon at the back of your heel bone. Many of your large joints have a bursa around them. They provide cushioning and lubrication for the tendons, muscles and bone. Bursitis of the heel occurs when the bursa in your ankle becomes swollen.

Causes
Improper foot wear, tight shoes or shoes that do not fit properly can cause extra pressure and friction on the back of the heel. Overtime, this pressure causes irritation of the bursae that protects the Achilles tendon causing one or both to swell and become inflamed. Athletes who overtrain or runners that increase their distance to quickly are at greater risk of experiencing Achilles bursitis. With over use, the Achilles bursae and tendon can become irritated and inflamed leading to thickening of the bursae lining and wearing of the tendon. Fluid builds in the bursa when it becomes irritated causing swelling of the Achilles bursa and pain at the back of the heel.

Symptoms
A dull ache under the heel when not weight bearing. Sometimes severe pain when walking. Pain can increase after resting (sleeping or sitting) then standing and placing pressure on the area again. Throbbing under the heel. Swelling may be identified as a discernible lump under the heel. This is the swollen calcaneal bursa itself. Tingling under the heel as swelling affect the plantar nerves. Pains shooting into the foot or up the leg.

Diagnosis
Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis, a fracture or tumor. A doctor also will try to determine if the Achilles tendon itself is a source of pain. To make a diagnosis, a doctor will use some or all of the diagnostic tools below Patient interview. A doctor will ask a patient about medical history, and to describe the onset of his or her symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask patients what types of shoes they wear and what they do for exercise. A patient's reported symptoms are important to diagnosis and treatment. The doctor will also ask what home treatments have helped the condition. Physical exam. A doctor will examine the patient's foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.

Non Surgical Treatment
Treatment is primarily comprised of relief from the painful activity (running). It is important that shoes do not pinch the heel. If satisfactory progress is not made during the rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the bursa. Injections should be performed under ultrasound guidance to ensure optimal effect and reduce the risk of injecting into the Achilles itself. If progress is not made neither through rehabilitation nor medicinal treatment, surgical treatment can be attempted.

Surgical Treatment
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

Prevention
You may be able to prevent bursitis from happening or coming back. Continue your home treatment with rest, ice, pain relievers, and gentle exercises. When you are ready to try the activity that caused the pain, start slowly and do it for short periods or at a slower speed. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. Use ice afterward to prevent pain and swelling. Change the way you do activities with repeated movements that may strain your muscles or joints. For example if using a certain tool has caused bursitis, start switching hands or change the grip size of your tool. If sitting for long periods has caused bursitis, get up and walk around every hour. If a certain sport is causing bursitis, consider taking lessons to learn proper techniques. Have an expert check your equipment to make sure it's well suited to your size, strength, and ability. If certain activities at work may be causing bursitis, talk to your human resources department about other ways of doing your job, equipment changes, or other job assignments. Protect your joints from pressure. Cushion knees or elbows on hard surfaces, and wear shoes that fit you well and have good support.