In this article, we provide all the information you need to know about the common causes of bursitis foot and the most effective ways to treat it. A bursa is a sac-like structure present close to numerous bony prominences in the body. It is usually found between bones, muscles, ligaments, and tendons. More specifically, the parts of the foot that are commonly associated with Foot Bursitis are the bunions, Achilles, bottom of heels, and back of the heels. There is more than 150 bursa in the body, and their role is to promote musculoskeletal movements. They allow this by creating a cushion between different tissues as they move against each other. However, when these bursae get inflamed, it can lead to Bursitis. (1)
Foot Bursitis, which may also be known as Retrocalcaneal Bursitis, occurs most commonly in the areas with the highest pressure. This may include the heel, big toe, and the fifth metatarsal head. These are all included in the tripod model. A balance of these three points promotes the distribution of weight along the surfaces of the foot and provides individual stability. An inflamed bursa is usually filled with fluid, and when it is pressed against ligaments, tendons, or bone, it causes different forms of foot pain to the individual. An example is the retrocalcaneal bursa, the inflammation of which can lead to heel pain. (2)
What Are The Symptoms of Foot Bursitis?
There are two forms of foot bursitis that may be experienced by individuals based on the onset of symptoms. This includes Acute and Chronic Bursitis. These symptoms of Bursitis can be differentiated from each on the basis of a detailed medical history and the patient’s daily routine. (3)
Acute Bursitis is triggered after a trauma, joint disease, or an infection. Patients often complain of pain when the affected area is palpated. They may also complain of a limited range of motion. This is because movements of any kind trigger pain.
Chronic Bursitis usually arises after repetitive overuse, pressure, micro-traumas, or conditions like inflammatory arthropathies; in contrast to Acute Bursitis, Chronic Bursitis of often not associated with any pain. However, over time the bursa expands on its own and makes space for the accumulated fluid. This may present with a large swelling or thickening of the affected bursa.
What are the Common Causes of Bursitis?
Foot Bursitis is most commonly caused by an injury or overuse of the area. Overuse of feet may be caused by excessive walking in ill-fitting shoes, high heels, or physical activity involving the feet against hard surfaces. This leads to added stress on the feet. An injury may also cause to the feet, which involves a sudden impact caused by contact sports or repetitive impact motion.
The condition which may further promote these causes include:
· Plantar Fasciitis: The fascia in the feet helps connect the heel bone to the base of the toes. These may become inflamed due to excessive walking, jumping, or other physical activities involving the feet. The heel pain caused by this is more commonly felt at the back of the heels.
· Haglund’s Deformity: Haglund’s deformity is another cause of foot bursitis, which involves the formation of a bump formed at the back of the heel. This is where the Achilles tendon is found. This condition is most commonly caused by using ill-fitting shoes, which may continually rub against the back of the foot.
· Achilles Tendinopathy: As the name suggests, Archilles Tendinopathy is the inflammation of the Achilles Tendon.
· Severs Disease: Severs disease is most commonly seen in growing children, as their heel is still growing. When excessive pressure is put on the heel, it can cause tightening of the tendons, in turn injuring the surrounding structures. This may also be known as calcaneal apophysitis.
· Pinched Nerve: Pinched nerve or trapped nerve is another condition promoting the onset of foot bursitis. The pinching of nerves may cause the individual to experience sharp pain.
· Heel Spur: Heel Spur is caused by a calcium deposit that forms between the heel bone and fascia. Studies show that the majority of individuals with heel spur may not exhibit signs of pain, while 10% may report pain.
Moreover, medical conditions like diabetes, thyroid, gout and rheumatoid arthritis, metatarsal tendinitis, and toe joint injections may also cause the condition – however, this is comparatively rare.
How is Foot Bursitis Diagnosed?
The diagnosis of foot bursitis may start with the health professional asking you about the type of pain and where it originates from. You may also be asked about your activity levels and daily routine. The questions you may be asked include:
· What are the exercises you indulge in every day?
· What sports do you play?
· How many hours during the day do you spend standing?
· Does your work include a lot of repetitive motions?
This may be followed by conducting a detailed examination of the foot to look for deformities like Haglund’s Deformity. They may also conduct X-rays, MRIs, or ultrasounds of the affected joint. After a general examination, if a deformity or injury of the foot is expected, the doctor may refer you to a podiatrist. (4)
How is Foot Bursitis Treated?
Many of the structures in the foot have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.
Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.
As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.
Other less effective treatments include:
· Counseling of athletes and individuals with high daily physical activity to cut down on their training until their Bursitis is healed. They may be asked to use athletes’ shoes with proper support, insoles, and inserts. For individuals with Bursitis close to the Achilles tendon, wearing proper-fitting shoes is recommended.
· Recommendation of stretching and strengthening exercises. They may also be recommended to visit a physical therapist and undergo regular physical therapy. The physical therapist may also recommend splints to wear at night.
· Recommendation of over-the-counter pain killers and anti-inflammatory medication like non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Naproxen Sodium to reduce inflammation and pain. Steroids may be recommended in more advanced cases where regular painkillers do not control the pain and inflammation. The prescribed cortisone is available in the form of creams and oral pills. Injections of corticosteroids are not recommended, as they may increase the risk for skin atrophy, iatrogenic Bursitis, and local tendon injury. Since the Corticosteroid injection decreases the pain, it may delay the prognosis of associated conditions like Rotator Cuff tears. (5)
· Systemic Antibiotics are recommended for conditions like Septic Bursitis, particularly the ones active against gram-positive bacteria. These patients may be treated with oral antibiotics, and they do not require to be admitted to the hospital. However, they may be required to be admitted to the hospital if the whole joint is involved or the infection has spread to the blood. (6)
· Other treatments may be more specific for the cause of the condition causing Bursitis. These may include medications and orthotics for arthritis, osteoporosis, or gout prescribed by the podiatrist.
Prevention of Foot Bursitis
Foot Bursitis can be prevented by the following recommendations, which are commonly made by the majority of health experts:
· Always wear well-fitted shoes. Since Bursitis is most commonly caused by wearing ill-fitted shoes, an individual should avoid wearing shoes that either have very high heels or are shaped to compress the tendons. It is also ideal to have shoes with good cushioning, particularly on the heel area.
· Use padded socks. The padded socks help protect the feet and prevent the formation of bursae.
· Always try to take out time to warm up before any active physical activity.
· Try to avoid walking barefoot on hard and rocky surfaces.
· Try to lose weight if you are above the recommended BMI. This may help take off the excessive stress on the heels.
Frequently Asked Questions
How long does Foot Bursitis take to heal?
Proper diagnosis and early treatment are essential to the successful healing of foot bursitis. The majority of the individual may feel a significant improvement in their symptoms only after half a month of treatment. However, more serious cases with excessive inflammation and infection may take up to one year.
Does Foot Bursitis go away?
Foot Bursitis requires adequate management therapies to heal. These may be in the form of medication, ointment, steroids, or even surgical procedures. In the majority of cases, the symptoms of Bursitis are corrected within a few weeks following treatment. However, adequate treatment may also lead to the recurrence of the condition.
How do you get Bursitis to go away?
Foot Bursitis may be initially managed with at-home therapies like taking adequate rest and applying ice to the affected area. This will help target the inflammation, which is the main factor behind the foot pain seen in Bursitis. However, the individual may also be prescribed painkillers for excessive pain. If over-the-counter pain killers are ineffective in treating the symptoms, the doctor may recommend the individual oral Steroid pills. Injections of steroids are not recommended as they may lead to complications like atrophy of skin and tendon injuries.
What does Bursitis in the foot feel like?
The pain of Bursitis usually presents as a dull ache in the feet. However, the individual may also experience swelling in their feet due to accumulated fluid in the inflamed bursa. This pain may particularly be triggered by wearing tight shoes or high heels. It may also be more common in individuals who spend the majority of their time on their feet or indulge in excessive physical activity like running, jumping, and lifting weights.
1. 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/
2. Zanetti, M., & Weishaupt, D. (2005). MR imaging of the forefoot: Morton neuroma and differential diagnoses. Seminars in musculoskeletal radiology, 9(3), 175–186. https://doi.org/10.1055/s-2005-921938
3. 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/
4. Zidani H, Genah I, Lae M, Bousson V, Laredo JD. Adventitious bursitis in the plantar fat pad of forefoot presenting as a tumoral mass. J Radiol Case Rep. 2020;14(2):12-20. Published 2020 Feb 29. doi:10.3941/jrcr.v14i2.3711
5. 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/
6. 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/