Bursas are small fluid containing sacs, that are situated between areas of high friction such as bone against the floor (heel) and bone against other soft tissue structures like tendons, skin and or
muscle. The bursa job is to act as a shock absorber, and to allow stress free movement between the above noted structures. Bursitis is a swellinginflammation of the bursa sac, due to constant micro
trauma or overuse. In the foot Abnormal Pronation, most often caused by Morton?s Toe.
Age. Bursitis is more common during middle age due to repetitive activities that put wear and tear on the body over time. Certain activities or occupations. If your job or hobby involves repetitive
motion or puts pressure on bursae, you have a higher likelihood of developing bursitis. Reaching overhead, leaning elbows on arm rests, crossing your legs, laying carpet, setting tile, gardening,
biking, playing baseball and ice skating are some activities that, when repeated very often, can put you at increased risk of developing bursitis. Sports in which you may get hit in the knee or fall
to the knees, such as football, can also increase the risk. Some medical or health conditions. Rheumatoid arthritis, osteoarthritis, gout, thyroid disease, diabetes, alcoholism and some
immunosuppressive disorders can increase the risk of bursitis. The reasons can vary, from cartilage breakdown around joints (arthritis) to crystals in the bursa that cause inflammation (gout).
Wearing high heels. Posterior Achilles tendon bursitis occurs when the bursa located between the skin and the Achilles tendon (the band of tissue that attaches the calf muscle to the heel bone)
becomes inflamed. High heels are often to blame for this, the stiff heel can put direct pressure on the bursa between the skin and the Achilles tendon.
Symptoms of bursitis usually occur after rest and relaxation. Upon activity there is usually more intense pain in the area of the bursa. The common areas to have a bursitis in the foot are in the
bottom of the heel, behind the heel near the attachment of the Achilles Tendon as well as along the side of a bunion. A bursa may also form in multiple areas especially along the metatarsal heads, or
"ball" of your foot. You may actually feel the sac like fluid when rubbing the area of pain.
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
In addition to R.I.C.E., there are a number of other treatments to reduce swelling and any associated pain or discomfort due to heel bursitis. Orthotics or change of footwear. Wearing an orthotic
device such as a heel insert can encourage better mechanics in the foot and reduce irritation of the retrocalcaneal bursa. Some people do not need special orthotics but simply need to stop wearing
shoes with rigid heel and ankle construction and instead wear more supportive, comfortable shoes. Shoes with an "Achilles notch," a groove in the collar at the back of the shoe to protect the
Achilles tendon, can be particularly helpful. (Almost all running shoes are designed with an Achilles notch.) Stretching and physical therapy. Stretching the Achilles tendon often helps alleviate
pain. Once the pain is resolved it is important for the patient to continue a regular stretching program. Regular stretching reduces the chance of recurrence.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.
Once your pain and inflammation is gone, you can prevent retrocalcaneal bursitis deformity by wearing the best shoes for your foot type. You should high-heels and pumps if possible. Wear orthotics
(custom arch supports) or over-the-counter orthotic devices. Perform frequent Achilles tendon stretching exercises to prevent it from becoming tight agian. Avoiding running uphill when training. Try
to run on softer surfaces and avoid concrete.