Treatment For Bursitis Of The Foot

Overview

A bursa is a fluid-filled sac. There are hundreds of deep and superficial bursae throughout the human body. They are typically located near major joints. Bursae are situated between bone and soft tissues like tendons, ligaments, muscles, and skin. They serve as a cushioning pad to absorb shock. The fluid within the sac is secreted to assist with friction-free movement as the soft tissues move across a bony area.

Causes

Occasionally the bursal sac can become inflamed and painful. Pain to the region is worse typically with initial weight bearing activity such as rising from bed in the morning. Swelling and warmth to the region are common. Clinical examination shows pain to palpation at the retrocalcaneus at a level just before the Achilles tendon. Increase pressure and friction of the Achilles tendon across the retrocalcaneal region is the cause of this bursitis. A high arch, tight Achilles tendon or bone spur appear to be some of the main causes of this problem. With a high arch the back portion of the calcaneus abnormally projects into the Achilles tendon region.

Symptoms

The main symptom of heel bursitis is pain. You may experience pain in your heel when you walk or run. There may also be pain if the area is touched or if you stand on your tiptoes. In addition to pain, the area may appear red and warm, which are both signs of inflammation. Even if you have these symptoms, only a doctor can determine if you have bursitis of the heel. Your doctor will use these symptoms along with a general exam to determine if you are suffering from bursitis of the heel.

Diagnosis

Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis, a fracture or tumor. A doctor also will try to determine if the Achilles tendon itself is a source of pain. To make a diagnosis, a doctor will use some or all of the diagnostic tools below Patient interview. A doctor will ask a patient about medical history, and to describe the onset of his or her symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask patients what types of shoes they wear and what they do for exercise. A patient's reported symptoms are important to diagnosis and treatment. The doctor will also ask what home treatments have helped the condition. Physical exam. A doctor will examine the patient's foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.

Non Surgical Treatment

Most bursitis cases can be treated by the patient without having to see a doctor. A trip to a pharmacy, a conversation with the pharmacist, and some self-care techniques are usually enough. The NHS (National Health Service, UK) recommends PRICEM, a self-care management approach. PRICEM stands for Protection. Rest. Ice. Compression. Elevation. Medication. Protect the affected area, Some people place padding to protect the affected bursae from any blow. Rest. Do not exercise or use the joints in the affected area unless you really have to. Let it rest. Bursitis is a condition that responds well to rest. Ice packs. Ice packs can help reduce pain and inflammation. Make sure you do not place the ice directly on the skin, use a pack or towel. A small pack of frozen vegetables are ideal. Raise the affected area. If you can, lift the affected area, raise it, less blood will gather there. This may help reduce the inflammation. Painkillers. Ibuprofen is an effective painkiller for treating pain, it also reduces inflammation. Steroids. For more severe symptoms the doctor may inject steroids into the affected area. Steroids block a body chemical called prostaglandin. Prostaglandin causes inflammation. Steroids may raise the patient's blood pressure if used for too long, as well as increasing his/her risk of getting an infection. UK doctors are advised not to give more than three steroid injections in one year. Antibiotics. If the fluid test confirms that there is a bacterial infection, the doctor will probably prescribe antibiotics. These will be administered orally (via mouth).

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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