Bursitis: Foot Causes, Symptoms and Treatment
Bursitis is the inflammation or irritation of the bursa. Read this article to find out more on the causes, symptoms, and treatment of bursitis.
What Is Bursitis?
To put it simply, bursitis is inflammation. Bursitis is the swelling of the bursa sac that surrounds the joints in your body. The bursa is made up of synovial membrane and filled with synovial fluid. The bursa plays an important role that cushions the bones to avoid the bones rubbing directly against other structures such as muscles and skin. Bursitis is the inflammation of these sacs and becomes very painful.
Bursitis is generally a recurring injury, however it is treatable and preventable for future. Bursitis usually resolves within a few days to weeks but can become chronic if the symptoms are not addressed and adequate interventions do not take place.
Causes and Risk Factors
Bursitis occurs when the bursae becomes irritated and inflamed most commonly from overuse, such as continuous movement in a particular way that creates constant friction on the bursae. Some common causes of bursitis are:
Age: with age our tendons become less elastic and do not perform under excessive load as well as previously
Occupation: work that is demanding on the body and requires repetition are more likely to cause bursitis
Hobbies/Exercise: sports such as tennis, running, baseball and cycling that involve repetitive movements are at risk. Additionally, hobbies such as painting, gardening and gaming are also at risk.
Medical Conditions: musculoskeletal conditions such as pronation, leg length discrepancy, previous injury and scoliosis may create extra strain on a bursa leading to a higher risk or bursitis. Arthritis or inflammatory arthritis such as gout, rheumatoid arthritis and psoriatic arthritis also places additional risk as it may put pressure on a bursa.
There are many different causes of bursitis and types of bursitis; a combination of the above factors may determine the affected area of the body where your bursitis symptoms occur. A bursa may contract an infection if the bursa is close to the skin and there it an open wound or break in the skin. If you are concerned that you have septic bursitis and have a fever seek medical advice immediately. A doctor or the emergency department will be able to inspect your affected area, pain levels and health/medical conditions and rule out other possible conditions.
There are over 150 bursae in the human body. The most common locations where inflammation of a bursa arise are the shoulder, elbow, hip along with the following types of bursitis:
- Knee: Prepatellar Bursitis – at the front of the knee, Pes anserine Bursitis – at the inner knee
- Buttocks: Ischiogluteal Bursitis – between the pelvic bone and gluteal muscles
- Hips: Trochanteric Bursitis – trochanteric bursitis is generally the outside point of the hip
- Thighs: Iliopsoas Bursitis – starts at top of the hip and radiates down the thigh
- Ankles and heels: Retrocalcaneal bursa – between the Achilles tendon and the heel bone, Subcutaneous calcaneal bursa – between the skin and the insertion of the Achilles into the heel bone and Plantar calcaneal bursa – between the heel bone and the plantar fascia Big toes and little toes
Depending on the type of bursitis you need to see a doctor, or the doctor may refer you to the appropriate health professional.
Bursitis can present in many different ways and it can often be confused for other pathologies. It is important to see a professional if you are experiencing any of the following symptoms.
Bursitis can occur suddenly from trauma or high impact or worsen over time. The joint of your affected area may feel achy and stiff, which can be mistaken for arthritis being so close to the joint. Pain can be elicited when pressing down on the joint and bursae and when moving or rotating the joint. The area may be swollen and show signs of redness and heat.
Bursitis has the associated risk of becoming infected when the bursae is close to the skin where bacteria may penetrate the bursae, causing pain, fever and chills. This is called septic bursitis.
Septic bursitis typically affects the knee and the elbow, but infection may occur within any bursa and surrounding soft tissue in the body.
A large variety of preventative measures can be undertaken to prevent flare ups of bursitis. The fluid filled bursa can be temperamental however taking precautions and preventive measures should help the soft tissue be more efficient in meeting demands of repetitive tasks.
This can include
- Good ergonomics such as posture in office chairs where the hips, knees and ankles are taken into consideration.
- Maintaining a healthy weight to manage the load through the joints.
- Using good lifting methods and reducing the repetitive movements by taking lots of breaks.
- Stretching before undertaking exercise or labour intensive activity to assist the joints to move through full range of motion and enable the muscles, bones and tendons to work at their maximal efficiency. This is especially important as labouring professions given their work movements are one of the most common causes of bursitis.
- Strengthening the muscles to cope with higher loads and reduce strain from the joints.
Overuse injury particularly in hip, foot and knee bursitis can arise from being on a hard surface. Using multiple surfaces and having a range of working floor environments can prevent bursitis. It is important to note what type of bursitis you have to be able to incorporate the appropriate preventative methods.
Imaging is a standard practice in gaining a diagnosis along with the symptoms you present with and assessments within the clinic. An x-ray may be suggested in order to rule out other pathologies. An ultrasound or MRI may be ordered to gain more information surrounding the injured tissue.
Occasionally an analysis of the fluid filled sac from the bursa may need to be completed. A blood tests is not uncommon if there is a suspected risk of infection coupled with swelling, redness and fever. This may help in identifying many things that may include inflammatory markers, a medical condition, best line of treatment or when to see a specialist doctor.
There are many different methods of treatment that a podiatrist can facilitate with the healing process of your bursitis and the management of potential future flare ups. Once a bursa has become inflamed and we know what your bursitis is caused by, we can aim to minimise pain and inflammation with some of the following common treatments.
R.I.C.E – Resting the feet is an essential part of the inflammatory process. Ice helps reduce acute pain and swelling (if there is no swelling present heat may be more appropriate – see below). Compression will also assist in pain management and the control of swelling. Elevation of the foot above your heart using pillows or a ledge whilst laying down will do the trick.
NSAIDS – Non-steroidal anti-inflammatory drugs can be topical or oral. An oral NSAID such as Ibuprofen are recommended to help with the feeling of stiffness and aching of your joints when bursitis is present. Alternatively a topical NSAID such as Deep Heat is a fast and effective way to target the painful area and helps to increase blood flow to the injury.
Footwear – Having shoes that provide adequate depth and width whilst remaining well cushioned are features that will reduce friction and lateral pressure
Shockwave therapy – encourages blood supply, nutrients and neural awareness of healing. If the injury is chronic and has been present a long time, shockwave can re-boot the acute healing process of the tissue, ultimately reducing the inflammation of a bursa.
Padding and strapping – provide temporary relief by supporting the inflamed and injured structures. A metatarsal pad is extremely effective.
Orthotics – Orthotics aid the redistribution of areas of high strain and load and shift the pressure to other structures within the foot. A combination of good footwear and orthotics ultimately reduce friction between tissues and can both prevent bursitis and treat bursitis
Surgery may be considered if symptoms have not resolved after 6-12 months.
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