Bursitis Foot Pad

Overview

The most common bursa to be inflamed in the foot is the retrocalcaneal bursa (also referred to as the subtendinous calcaneal bursa). Located between the Achilles tendon and the heel bone (calcaneus), this is a "true" bursa that is present from birth. It acts as a cushion to protect the Achilles tendon from friction against the heel bone. Also commonly affected, the subcutaneous calcaneal bursa (also referred to as the Achilles bursa), located between the Achilles tendon and the skin, sits a little lower down the ankle towards the heel than the retrocalcaneal bursa. This bursa develops as you age, an "adventitious" bursa, to protect the tendon from friction at the back of the heel.

Causes

A bursa is a fluid-filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel, where the large Achilles tendon connects the calf muscles to the heel bone (calcaneus). Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for achilles tendonitis. Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.

Symptoms

Pain when activating the Achilles tendon (running and jumping) and when applying pressure at the point of attachment of the tendon on the heel bone. Contrary to the tenderness occurring with inflammation of the Achilles tendon, the tenderness is localised to the point of attachment to the heel bone.

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

Many cases of retrocalcaneal and retroachilles bursitis can be treated effectively at home. One of the most important factors is eliminating shoe gear that presses against the back of the heel. Comfortable, supportive footwear and frequently resting the foot will minimize friction at the heel and give the inflammation a chance to subside. These steps, along with other methods to alleviate swelling, such as non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen), icing the heel, and elevating the foot, are usually successful in treating retrocalcaneal bursitis.

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.

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