Bursitis Of The Foot Physiology

Overview

Heel bursitis is also known as retrocalcaneal bursitis. The heel bone is called calcaneus, and the bursa associated with the heel bone is located in the area between the Achilles tendon and calf muscles. When this particular bursa gets aggravated due to constant pressure in the ankle, the posterior end of the heel or the area behind the heel gets inflamed and hence the result is retrocalcaneal bursitis. Strain to the ankles could be caused due to various reasons like extraneous jogging, skipping, or such physical activities that increase the pressure on the ankles.

Causes

Retrocalcaneal bursitis can be caused through injury or infection or be can be triggered by certain health conditions. If bursitis develops as a result of injury then it will normally be due to a repetitive strenuous activity that encourages the calf muscles (the gastrocnemius and soleus muscle), which attach to the heel bone via the Achilles tendon, to tighten and shorten from overuse, for example repetitively wearing high heels, running and even wearing tight shoes that pinch at the back of the heel. This puts more pressure over the bursa as the tendon rubs more tightly over it, irritating it and triggering a painful inflammatory reaction (swelling). This risk of developing bursitis in this way is greater for those whose jobs or hobbies involve a lot of repetitive movements, for example carpet fitters and gardeners who spend a lot of time kneeling and so are more at risk of bursitis in the knee. Runners have a greater likelihood of developing bursitis in the hip. Bursitis can also be brought on by excessive pressure or direct impact trauma, such as banging your elbow or dropping on to your knees. Infection is a less common cause of bursitis and normally only occurs in people who have a weakened immune system from other health issues. The infection can work its way to the bursa from a cut close to the bursa that has become infected, in these cases the bursitis is termed as septic bursitis. Certain health conditions can also trigger the development of bursitis, such as rheumatoid arthritis and gout, amongst others.

Symptoms

Pain and tenderness usually develop slowly over time. Applying pressure to the back of the heel can cause pain. Wearing shoes may become uncomfortable. The back of the heel may feel achy. Pain is exacerbated when the foot is pointed or flexed, because the swollen bursa can get squeezed. A person with retrocalcaneal bursitis may feel pain when standing on their toes. Fever or chills in addition to other bursitis symptoms can be a sign of septic bursitis. Though uncommon, septic retrocalcaneal bursitis is a serious condition, and patients should seek medical care to ensure the infection does not spread.

Diagnosis

Bursitis is usually diagnosed after a careful physical examination and a full review of your medical history. If you garden and spend a lot of time on your knees, or if you have rheumatoid arthritis, tell your doctor, this information can be very helpful. During the physical exam, he or she will press on different spots around the joint that hurts. The goal is to locate the specific bursa that is causing the problem. The doctor will also test your range of motion in the affected joint. Other tests usually aren?t required to diagnose bursitis, but your doctor may suggest an MRI, X-ray or ultrasound to rule out other potential causes of pain.

Non Surgical Treatment

The underlying cause of the bursitis must be identified to prevent further reoccurrences. Failure to eliminate the cause will lead to future flare ups and a poor and slow recovery. Future occurrences can be prevented with the use of stretches and strengthening exercises which will help prevent the muscles from tightening up over the bursa, Pilates and yoga are very good for this providing the aggravating movements are avoided. Wearing joint supports such as knee pads or elbow supports may also reduce the likelihood of redeveloping bursitis.

Surgical Treatment

Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.