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Bursitis Of The Foot Bursa Removal Complications

August 27, 2015
Overview

Heel pain can also be caused due a condition called Bursitis which is constant irritation of the heel's natural cushion (bursa). This can lead to additional pain at the back of the heel when the ankle is moved and there may be swelling on both sides of the Achilles tendon. Useful treatments for Heel bursitis are anti-inflammatory medications such as aspirin and Ibuprofen gel/tablets. Cold ice-pack compresses can be useful in reducing any swelling. In conjunction to these treatments it is important to stabalise and protect the heel. Gel heel pads will help to let the inflamed bursa settle down, however in severe chronic cases sometimes the use of Cortisone injections may be indicated.

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

Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. Pain is typically experienced during activities requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes). Often pain may be worse with rest after these activities (especially that night or the following morning). The pain associated with this condition may 'warm up' with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region.

Diagnosis

Your doctor will take a history to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the achilles tendon over the inflamed bursa. Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the achilles tendon to the heel bone. Imaging studies such as X-ray and MRI are not usually necessary at first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.

Non Surgical Treatment

You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping. Ice. Place a plastic bag with ice on the foot for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications. Compression. Lightly wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold. Elevate. Make sure to elevate the ankle above heart level. To improve symptoms of plantar calcaneal bursitis after the acute phasetry the baked bean tin stretch, using a baked bean tin roll the foot backwards and forwards. 2 minutes in the morning before putting the foot to the floor. 5-10 minutes every evening. Contrast foot baths. 10 minutes warm water. 10 minutes cool water morning and evening (morning may be missed if time is restricted). Stretches. Start with 10 stretches per day, holding the stretch for 30 seconds, then relax and then repeat. Continue this stretch daily until you can no longer feel it pulling on the heel, then progress to stretch. Do 10 per day holding for 30 seconds per stretch. When you can no longer feel it pulling on the heel proceed to stretches. Do 10 per day holding for 30 seconds on every stretch.

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.

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