Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025
What Is Ankle Bursitis?
Bursitis is a painful condition characterized by inflammation of the bursa—small fluid-filled sacs that cushion and reduce friction between bones and tendons. In the ankle, the main bursae are the Achilles bursa, retrocalcaneal bursa, and medial malleolus bursa. Superficial inflammation may be called subcutaneous or pre-Achilles bursitis. (1, 2)
Common bursitis symptoms in the foot include localized pain, tenderness, and swelling, which worsen with movement or pressure. Treatment often starts with rest, ice, and anti-inflammatory medication. If conservative measures fail, corticosteroid injections or surgery may be considered.
Bursae can become inflamed due to overuse, direct trauma, repeated stress, or falls. Other risk factors include infection, rheumatoid arthritis, osteoarthritis, and gout. The main symptom is pain and discomfort with ankle movement.
The Achilles bursa is found at the back of the ankle near the Achilles tendon. Retrocalcaneal bursa pain is felt at the back of the heel, while medial malleolus bursa pain is felt on the inside of the ankle. Ankle bursitis may occur independently or with tendinitis.
Symptoms of Ankle Bursitis
There are two main types: acute and chronic bursitis. Acute bursitis is usually due to injury, trauma, infection, or joint disease, while chronic bursitis results from repeated micro-injuries and overuse. (3)
- Heel pain and pressure
- Swelling at the back of the heel
- Pain triggered by pressing on the heel
- Pain in supporting soft tissues
- Stiffness in the ankle joint
- Redness and warmth over the bursa
- Crackling sounds on flexing the foot
- Limited range of motion
Septic bursitis (infected bursa) may cause a temperature rise over the skin. Chronic bursitis may present with swelling and thickening of the bursa, often with less pain.
Causes of Ankle Bursitis
Common causes include:
- Overuse (e.g., running, sports, lack of warm-up)
- Poorly fitting shoes or high heels
- Infection (septic bursitis, often due to Staphylococcus aureus or Streptococci) (4)
- Inflammation in surrounding structures
- Systemic conditions: rheumatoid arthritis, osteoarthritis, gout, psoriatic arthritis, pseudogout, reactive arthritis
How Is Ankle Bursitis Diagnosed?
Diagnosis is based on history, physical exam, and imaging. X-rays are used for trauma, MRI for detailed evaluation, and ultrasound for visualizing the bursa and differentiating from cellulitis. Aspiration of bursal fluid may be performed to rule out infection (septic bursitis). A white blood cell count <500 in aspirated fluid usually indicates non-infectious bursitis. (5)
Ankle Bursitis Treatment Options
Both conservative and surgical approaches are used. Conservative treatment is effective for most cases, but surgery may be needed for conditions like Haglund’s deformity. (6, 7)
Conservative Treatment
- Rest and elevation
- Ice/cold packs several times a day
- NSAIDs (ibuprofen, aspirin) or acetaminophen
- Custom heel wedges to reduce stress
- Padding, proper footwear, and avoiding high heels
- Physical therapy and strengthening exercises
- Braces or casts if needed
If infection is present, antibiotics are prescribed. Corticosteroid injections may be used for deep bursae but are avoided in superficial bursae due to risk of complications. Treating underlying systemic conditions is essential.
Surgical Treatment
Surgery may be required for refractory cases or Haglund’s deformity (e.g., calcaneal ostectomy, Achilles tendon debridement, retrocalcaneal bursa excision). (8) The Achilles tendon splitting approach is often used for Achilles bursitis.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat ankle bursitis. Published research has proven its pain-relieving, anti-inflammatory, and regenerative benefits. Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with ankle bursitis. As prolotherapy is helping to treat the root cause of ankle bursitis, it is deemed to be a permanent fix, preventing the symptoms from returning.
Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.
Frequently Asked Questions About Ankle Bursitis
How do you treat bursitis of the ankle?
Rest, ice, compression, elevation, and NSAIDs are first-line. Steroid injections may be used for deep bursae. Physical therapy and proper footwear are important.
How long does bursitis last in the ankle?
Mild cases improve in 2–3 weeks; severe cases may take up to 12 months. (9)
What causes bursitis to flare up?
Infections, trauma, or crystalline joint diseases cause acute flares. Chronic bursitis is triggered by repetitive microtrauma. (9)
Can bursitis heal on its own?
Most cases resolve with rest, ice, and activity modification. Some require medical intervention or physical therapy.
Is walking good for bursitis?
Walking is generally safe if done with proper footwear and not overdone. Consult a professional for guidance. (10)
What happens if bursitis is left untreated?
Untreated bursitis can cause permanent thickening/enlargement of the bursa, chronic pain, and muscle atrophy.
Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call
Don’t let ankle bursitis control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.
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Author Bio
Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating ankle bursitis, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with ankle bursitis and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
References
- Canoso, J. J., Liu, N., Traill, M. R., & Runge, V. M. (1988). Physiology of the retrocalcaneal bursa. Annals of the rheumatic diseases, 47(11), 910–912. https://doi.org/10.1136/ard.47.11.910
- Doral, M. N., Alam, M., Bozkurt, M., Turhan, E., Atay, O. A., Dönmez, G., & Maffulli, N. (2010). Functional anatomy of the Achilles tendon. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 18(5), 638–643. https://doi.org/10.1007/s00167-010-1083-7
- Williams CH, Jamal Z, Sternard BT. Bursitis. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513340/
- Truong J, Mabrouk A, Ashurst JV. Septic Bursitis. [Updated 2022 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470331/
- Foster, Z. J., Voss, T. T., Hatch, J., & Frimodig, A. (2015). Corticosteroid Injections for Common Musculoskeletal Conditions. American family physician, 92(8), 694–699.
- Fiamengo, S. A., Warren, R. F., Marshall, J. L., Vigorita, V. T., & Hersh, A. (1982). Posterior heel pain associated with a calcaneal step and Achilles tendon calcification. Clinical orthopaedics and related research, (167), 203–211.
- McGarvey, W. C., Palumbo, R. C., Baxter, D. E., & Leibman, B. D. (2002). Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach. Foot & ankle international, 23(1), 19–25. https://doi.org/10.1177/107110070202300104
- Pauker, M., Katz, K., & Yosipovitch, Z. (1992). Calcaneal ostectomy for Haglund disease. The Journal of foot surgery, 31(6), 588–589.
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Bursitis: Overview. 2018 Jul 26. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525773/
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How can Bursitis be treated? 2018 Jul 26. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525763/
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.