Bony prominences of the body are protected with soft tissue and fluid-filled sacs called Bursae. These sacs act as cushions near the joints between the bones and tendon/muscle insertion, Inflammation of these fluid-filled sacs is called bursitis.
In the foot, these bursae are found at the ball of the foot near the joints that the foot forms with the toes (MPJs), the base of the 5th metatarsal and the back of the heel where the achilles tendon inserts.
Chronic irritation and repetitive motion can cause these bursae to inflame. This can either be due to improper shoe gear or due to abnormal foot structure. Haglund’s deformity of the heel is one such example where there is abnormal bony prominence which gets irritated with shoe gear and can be very painful.
Another common example of bursitis is at the ball of the foot. Patients who have a tight achilles heel cord (equinus) tend to excessively overload the ball of the foot with weight bearing. This causes callus buildup on the ball of the foot and inflammation of the bursa protecting the metatarsal heads.
Symptoms are consistent with pain during weight bearing. Certain shoe types can exacerbate the pain as is the case with retrocalcaneal bursitis in patients with Haglund’s deformity. On the other hand, bursitis of the ball of the foot can be relieved by more supportive shoe gear. Ice to the affected area provides relief and so can NSAIDs such as ibuprofen or naproxen.
X-rays are taken in the office to see the overall foot type and to rule out other pathology that may cause similar pain. Patients with high arches tend to overload the ball of their foot with weight bearing which causes bursitis. Similarly, Haglund’s deformity and retrocalcaneal exostosis can be diagnosed on X-ray which also presents with bursitis.
Treatment includes Rest, Ice, compression and elevation along with shoe gear modification. At times a short course of steroids or a potent NSAID is used to calm the inflammation down. Physical therapy and conditioning exercises may also be utilized. Shoe gear modification and custom orthotics are a mainstay of treatment. Surgical intervention is often necessary when conservative treatment fails. This is likely the case with chronic posterior heel pain where bursitis recurs due to the abnormal bony prominence. The bony prominence is surgically resected to relieve pressure on the bursae.
Please see our expert doctors for a complete evaluation and treatment.