Foot Bursitis
Bursitis is a fairly common condition that we help our patients with. Foot bursitis can occur in the heel (retrocalcaneal bursitis) or in the ball of the foot (intermetatarsal bursitis) with both types causing pain, inflammation and difficulty performing normal movements.
Fortunately, bursitis responds well to the right treatment which is often a combination of home remedies and podiatry treatment. Keep reading to discover the symptoms of bursitis, what causes it and how we can help you get back on your feet.
What is bursitis?
In order for our joints to move, tendons, ligaments, muscles and skin must also move. Tiny, fluid-filled sacs called bursae, allow for this motion by cushioning the bones, tendons and muscles, and easing friction and rubbing of the joints. These fluid sacs are found all over our body, including our feet.
Sometimes these can become inflamed and painful. This is known as bursitis.
In the foot, there is only one naturally occuring bursa, which is located between the Achilles tendon and the heel bone (calcaneus). However, our body also creates other bursal sacs during ‘micro-traumas’ like running, walking and jumping, to protect areas of our feet. These can also form in injured areas of your foot and ankle.
Symptoms of foot bursitis
There are two types of foot bursitis:
When the bursae around the heel become inflamed.
The primary symptom of this type of foot bursitis is pain around your heel. You might also notice:
- swelling around the heel
- pain when leaning back on your heels
- heel is painful to the touch
- calf muscle pain when running or walking
- stiffness and/or limited range of motion
- red or warm skin on the heel
- increasing pain, especially when standing on your toes or bending your foot
- crackling sound when you flex your foot
- you feel uncomfortable wearing shoes
- stiffness in the joint
When the bursae in the ball of the foot become inflamed.
The metatarsal heads are commonly known as the balls of the foot. Sometimes the bursae in this area can become inflamed as well causing pain in the ball of the foot. Common symptoms include:
- pain in the ball of the foot, while standing, or standing on toes
- feeling as if you are standing on a pebble or you have a stone in your shoe
- tenderness when you push off the ball of the foot when walking
- swelling in the front part of your foot
- pain when walking barefoot, or in flat, hard shoes
- reduced movement in the front of your foot
Often intermetatarsal bursitis presents in conjunction with other foot problems including Mortons neuroma (an irritation and swelling of the nerve that runs between the metatarsals).
Because other foot problems can cause similar pain to intermetatarsal bursitis, it’s important that you see a podiatrist in order to diagnose your condition accurately.
What causes bursitis in the feet?
The most common cause of retrocalcaneal bursitis is overusing the heel and ankle area. Walking, running or jumping can all contribute, which is why this condition is common in runners, ballet dancers and other athletes.
It can also be caused by medical conditions such as gout, and Haglund’s deformity.
Intermetatarsal bursitis can also be caused by overuse and injury, as well as wearing inappropriate footwear (especially pointed or high-heeled shoes), and structural issues with the feet.
Who is at risk of developing foot bursitis?
Anyone can develop bursitis, but you have an increased risk if you:
are over 65 years old
wear poorly fitted shoes
have diabetes
have other foot conditions such as hammer toes or bunions
have arthritis or gout
have sustained injuries to your foot
don’t stretch properly before exercising
participate in high-activity sports
have tight muscles
have a job that requires repeated movement and stress on the joints.
How is foot bursitis diagnosed?
Diagnosing bursitis will involve a physical examination to check for signs of tenderness, swelling and redness, as well as taking your medical history. We’ll also ask questions about the type of activities you do and what kind of pain you experience. Because foot bursitis has similar symptoms to other foot conditions, it may also be necessary to take an x-ray, ultrasound or MRI, or even remove some fluid from the bursa to confirm the diagnosis and check if there is an infection.
Treatment for foot bursitis
home treatment
Fortunately, bursitis usually responds well to home-based, conservative treatments. The following is recommended:
- Taking a break from your regular activities and resting the affected area
- Elevating your foot where possible
- Applying ice to the affected area several times a day
- Taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
- Wearing supportive shoes that cushion your feet.
Podiatry treatment
We can also help you on the road to recovery by providing you with orthotics or other shoe inserts to help take the pressure off your foot while it heals. We can also advise you on exercises and stretches to aid healing and to reduce the risk of getting bursitis again.
Fortunately, bursitis will usually respond well to this kind of treatment. For severe pain that doesn’t respond to the above treatments, cortisone injections can be given, although this isn’t required very often. If after 6-12 months there is little or no improvement, surgery may be necessary. Fortunately however, the need for surgery is quite rare.
Preventing bursitis
There are many things you can do to prevent bursitis. These include:
- Ensuring that you wear well-fitting, supportive shoes with plenty of room across the toes
- Wearing padded socks to cushion your feet
- Warming up properly before playing sport or engaging in physical activity
- Avoiding walking barefoot on hard, uneven or rocky surfaces
- Maintaining a healthy weight to take pressure off your feet.
Like many foot conditions, the sooner you seek treatment the better the outcome, and the sooner you’ll be back on your feet — properly! If you’re experiencing any kind of pain in your feet, please make an appointment to see one of our friendly, experienced podiatrists.
frequently asked questions
Rubbing an anti-inflammatory cream like Voltaren may help ease your foot bursitis.
You can walk when you have foot bursitis to maintain your general health. However try limit the amount of prolonged weightbearing activities especially if you have severe symptoms.
When walking make sure to wear supportive footwear and avoid walking on uneven surfaces for prolong periods of times. If you have retrocalcaneal bursitis surfaces with sharp inclines may exacerbate the area.
There are some people who reported benefits from acupuncture for foot bursitis.
- Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011 Jun;19(6):359-67. doi: 10.5435/00124635-201106000-00006. PMID: 21628647.
- Weinfeld SB. Achilles tendon disorders. Med Clin North Am. 2014 Mar;98(2):331-8. doi: 10.1016/j.mcna.2013.11.005. PMID: 24559878.
- Albtoush OM, Xenitidis T, Horger M. Intermetatarsal bursitis as first disease manifestation in different rheumatological disorders and related MR-imaging findings. Rheumatol Int. 2019 Dec;39(12):2129-2136. doi: 10.1007/s00296-019-04381-x. Epub 2019 Jul 18. PMID: 31317220.
- Hammer HB, Kvien TK, Terslev L. Intermetatarsal bursitis is frequent in patients with established rheumatoid arthritis and is associated with anti-cyclic citrullinated peptide and rheumatoid factor. RMD Open. 2019 Oct 17;5(2):e001076. doi: 10.1136/rmdopen-2019-001076. PMID: 31673423; PMCID: PMC6803004.
- Jain S, Mannan K. The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec. 2013 Aug;6(4):307-17. doi: 10.1177/1938640013493464. Epub 2013 Jun 27. PMID: 23811947.
- Zanetti M, Weishaupt D. MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol. 2005 Sep;9(3):175-86. doi: 10.1055/s-2005-921938. PMID: 16247719.
- Stell IM: Management of acute bursitis: Outcome study of a structured approach. J R Soc Med1999;92(10):516-521.
- Leitze Z, Sella EJ, Aversa JM: Endoscopic decompression of the retrocalcaneal space. J Bone Joint Surg Am2003;85(8):1488-1496.
- Stephens MM: Haglund’s deformity and retrocalcaneal bursitis. Orthop Clin North Am1994;25(1):41-46.
- Theobald P, Bydder G, Dent C, Nokes L, Pugh N, Benjamin M: The functional anatomy of Kager’s fat pad in relation to retrocalcaneal problems and other hindfoot disorders. J Anat2006;208(1): 91-97.
- Canoso JJ, Liu N, Traill MR, Runge VM: Physiology of the retrocalcaneal bursa. Ann Rheum Dis1988;47(11): 910-912.
- Schepsis AA, Jones H, Haas AL: Achilles tendon disorders in athletes. Am J Sports Med2002;30(2):287-305.
- Watson AD, Anderson RB, Davis WH: Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional achilles tendinosis with calcific spur. Foot Ankle Int2000;21(8): 638-642.
- Hugate R, Pennypacker J, Saunders M, Juliano P: The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons. J Bone Joint Surg Am2004;86(4):794- 801.
- Angermann P: Chronic retrocalcaneal bursitis treated by resection of the calcaneus. Foot Ankle1990;10(5):285- 287.
- Pauker M, Katz K, Yosipovitch Z: Calcaneal ostectomy for Haglund disease. J Foot Surg1992;31(6):588-589.
- Schneider W, Niehus W, Knahr K: Haglund’s syndrome: Disappointing results following surgery. A clinical and radiographic analysis. Foot Ankle Int2000;21(1):26-30.
- Healthline, Foot Bursitis and You, https://www.healthline.com/health/bursitis-foot
- Healthline, Retrocalcaneal Bursitis, https://www.healthline.com/health/retrocalcaneal-bursitis#symptoms
- Mayo Clinic, Bursitis, https://www.mayoclinic.org/diseases-conditions/bursitis/symptoms-causes/syc-20353242
- Cleveland Clinic, Foot and Heel Pain, https://my.clevelandclinic.org/health/articles/10060-heel-pain-common-causes-symptoms-and-treatments
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