At a glance:
- Bursitis is inflammation and pain caused by small fluid filled sacs in joints (bursa) becoming irritated and swollen
- There is only one naturally occurring bursa in the foot, but overuse or trauma may result in the formation of new bursae to help lubricate affected joints
- Bursitis of the heel is referred to as retrocalcaneal bursitis
- Bursitis of the forefoot is referred to as intermetatarsal bursitis
- Bursitis of the foot may be treated at home through a combination of wearing appropriate shoes, rest and NSAIDS, but it’s advisable to visit a podiatrist or physiotherapist for a diagnosis and advice before attempting any form of home treatment
What is Bursitis
Bursae are fluid filled sacs that protect joints. They are found throughout the body and help reduce friction in joints from movement. When one of these sacs becomes damaged or inflamed, it may cause pain and limit movement of the affected joint. This is referred to as bursitis.
There is only one naturally occurring bursal sac in the foot, found between the Achilles tendon and the heel bone. This does not mean that there aren’t any other bursae in the foot. Walking, running, jumping and other physical activities may cause micro-traumas in the foot leading to the development of adventitious bursal sacs in the many joints of the foot.
Continued trauma to any of the areas with a bursal sac may lead to inflammation and pain in the affected joint. Given the number of bones and joints in the foot, there are a lot of possible points of trauma.
Symptoms of Bursitis of the Foot
Symptoms may vary due to the location of the inflamed bursae. The two major forms of bursitis of the foot are referred to as Retrocalcaneal Bursitis (bursitis of the heel) and Intermetatarsal Bursitis (ball of the foot bursitis).
Symptoms of Retrocalcaneal Bursitis include:
- Inflammation, redness and pain in the heel
- Pain when putting pressure on or leaning back on the heels
- Heel stiffness
- Reduced movement in ankle
- A cracking sound when flexing the foot
- Shoes feeling tight on the heel or becoming uncomfortable
- Pain in the back of the heel at the top of a heel raise
Symptoms of Intermetatarsal Bursitis include:
- Pain in the ball of the foot when standing, walking or standing on your toes
- A sensation similar to standing on a pebble or having a stone in your shoe
- Pain or tenderness when pushing off the ball of your foot while walking
- Swelling in the forefoot, typically visible on the top of the foot
- Pain that is exacerbated by walking barefoot or in hard shoes but subsides when on a cushioned surface or while wearing well cushioned shoes
- Pins and needles in the toes or around the ball of the foot
- Reduced movement in the forefoot
What Causes Bursitis of the Foot?
There are a number of ways in which bursitis of the foot may be caused, as well as risk factors that may increase the likelihood of bursa and bursitis forming, including:
- Trauma or Injury - injuries from falls, impact, sprains, dislocations, accidents and the like may lead to the formation of bursa as well as cause trauma to existing bursal sacs.
- Repetition or Overuse - repetitive movements or overuse of joints may also lead to the inflammation of bursae. Walking, running, playing sports, standing for long periods of time and the like may all cause micro-traumas that may lead to bursitis of the foot.
- Shoes - poorly fitted or inappropriate shoes may cause excess pressure on parts of the foot, such as pinching the toes or heel. A lack of support and cushioning may also aggravate bursal sacs or existing bursitis.
- Bunions - Having a bunion may increase your risk of developing bursitis as the joint inflammation may lead to the development of a bursa in the big toe joint as well as other toes as the big toe pushes them together. A change of gait caused by a bunion may also change the way that pressure is spread over the foot, aggravating existing bursae.
- Hammer toes - having a hammer toe may put extra pressure on a joint or change the way pressure is spread around the foot, increasing the risk of developing bursitis of the foot.
- Arthritis/Gout - Having a condition that leads to inflammation of the joints, such as osteoarthritis, psoriatic arthritis, rheumatoid arthritis or gout increases your chances of both developing bursal sacs in the affected joint as well as causing trauma to those sacs.
- Diabetes - having diabetes increases your chances of developing many foot problems, including bursitis.
- Infection - in rare cases, an infection of a joint may spread to a bursal sac, resulting in inflammation, pain and bursitis.
- Abnormal Foot Shape - having abnormally high arches or flat feet may both increase your chances of developing bursitis of the foot.
- Age - as people age they lose elasticity and fat deposits in the sole that may help cushion the foot from trauma. People over 65 are more likely to develop bursitis than younger people.
Don’t stand around in pain, put your feet up and make an appointment to see a podiatrist or physiotherapist .
Treatment for Bursitis of the Foot
There are a number of effective options recommended for treating bursitis of the foot. In many cases, the condition may be treated without the need for prescription medication or invasive techniques, but in some cases prescribed treatments may be required.
Home treatments for bursitis of the foot include:
- Wearing comfortable and supportive shoes - making sure your shoes fit and give support where needed is one of the primary ways of easing stress on the affected area of the foot and reducing inflammation. Having ample toe room and cushioning may help alleviate intermetatarsal bursitis, and shoes with an “Achilles Notch”, a channel in the heel that supports the Achilles tendon may help with retrocalcaneal bursitis. Most running or cross training shoes have Achilles notches.
- R.I.C.E. - Rest, Ice, Compression and Elevation. Temporarily ceasing activities that may have aggravated the bursa, ice to reduce inflammation, compression for support and elevating the feet to relieve pressure are all effective ways of reducing the pain and discomfort of bursitis. Reducing the stress on feet through these techniques may also allow the body time to heal, reducing the inflammation.
- Non-Steroidal Anti Inflammatory Drugs (NSAIDS) - over the counter pain relievers, such as ibuprofen, aspirin or naproxen may help manage pain and reduce inflammation caused by bursitis.
In some cases, prescribed treatments may be required to treat bursitis of the foot. Possible prescribed treatment options include:
- Orthoses - prescription or over the counter orthotics may help reduce pressure on the calcaneal bursa. Prescription orthotics may also be used to correct the biomechanics of the foot, reducing the stresses that were the root cause of the bursitis.
- Corticosteroid Injections - these steroid injections have proven to quickly reduce the inflammation and pain of bursitis. They should be guided by an ultrasound image. The injection is used best when providing a pain free window to correct the root cause of the bursitis.
- Aspiration - in some cases the fluid from the affected bursa may need to be drained to relieve pressure. This is typically accomplished with a syringe.
- Antibiotics - in the rare case that the bursitis is caused by an infection or the bursa has become septic (septic bursitis), antibiotics are needed to clear the infection. Depending on the severity of the infection the antibiotics may be orally administered, or in severe cases may require hospitalisation for IV antibiotics.
- Surgery - in rare cases, surgery may be required to treat bursitis. This may be in the form of a bursectomy - the removal of the retrocalcaneal bursa or metatarsal bursae - or treating an underlying condition that may be the root cause of the bursitis.
If you have foot pain and inflammation in your heel or forefoot, you may have bursitis of the foot. The fastest, easiest and most foot-friendly way to search for and book medical appointments is to do it online with MyHealth1st.