A properly functioning heel is essential to normal, smooth, and painless gait. The heel is the first area to strike the ground during normal gait, which means it takes the brunt of the stress incurred during walking and running activities. Of course, this also means that the heel is highly prone to injury. One such injury is called heel bursitis.
Bursitis can develop for several reasons, including repetitively engaging in the same motion, or example, lifting objects above your head for work. Putting a lot of pressure on a bursa for an extended period of time. Leaning on your elbows or kneeling (for example, to lay carpet) can cause bursitis in the elbows or knees. If you sit for long periods of time, especially on hard surfaces, you may develop bursitis in your hip. Wearing shoes with a stiff back that rubs against the back of the ankle can cause Achilles tendon bursitis. Trauma. The bursae at the knee and elbow are close to the surface of the skin, and if you fall directly on your elbow or the knee, you can rupture, injure or puncture a bursa. Infection. Known as septic bursitis, it?s the result of bacteria infecting a bursa. It can occur from an infection traveling from another site or following an accident that ruptures the bursa. Even scraping the skin on your elbow or getting a mosquito bite that breaks the skin near the olecranon bursa (near the elbow) can lead to bursitis. Other joint disorders, such as rheumatoid arthritis, osteoarthritis and gout, or health conditions.
Symptoms of bursitis include pain in the heel, especially with walking, running, or when the area is touched. The skin over the back of the heel may be red and warm, and the pain may be worse with attempted toe rise (standing on tippy-toes).
Like all other forms of bursitis, initially the physician will take down the history of symptoms experienced by the patient, this will be followed by a detailed physical examination which involves checking for inflammation signs like pain, redness, and warmth of the heel area. The physician might examine further by moving the ankle a little to determine the exact location of pain. Further diagnostic tests including x-ray, bone scans, and MRI scan might be suggested if required.
Non Surgical Treatment
Your health care provider may recommend the following treatments. Avoid activities that cause pain. Ice the heel several times a day. Take nonsteroidal anti-inflammatory medications (for example, ibuprofen). Try over-the-counter or custom heel wedges to help decrease the stress on the heel. Try ultrasound treatment during physical therapy to reduce inflammation. Use physical therapy to improve flexibility and strength around the ankle, which can help the bursitis improve and prevent it from coming back. If these treatments don't work, your health care provider may inject a small amount of steroids into the bursa. After the injection, you should avoid stretching the tendon too much because it can break open (rupture). If the condition is connected with Achilles tendinitis, casting the ankle for several weeks to keep it from moving can be effective. Very rarely, surgery may be needed to remove the inflamed bursa.
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.
After taking a history and performing a physical examination, your physician may order x-rays to rule out other disorders. Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain. Also, to reduce swelling, your physician may draw excess fluid from the bursa with a syringe and then tightly wrap and compress the joint with an elastic bandage. In severe, persistent cases surgery to remove the bursa may be necessary. For infectious bursitis, antibiotics will be prescribed.