Conditions We Treat
Foot and Heel Bursitis
What Is It?
Bursitis is inflammation of a bursa—a small, fluid-filled sac that cushions and reduces friction between bones, tendons, and muscles. In the foot, bursitis most often affects the retrocalcaneal bursa (behind the heel) or the intermetatarsal bursae (between the metatarsal bones in the forefoot). It can develop from repetitive stress, poorly fitting shoes, or abnormal foot mechanics.
Symptoms
- Localized pain and swelling over the back of the heel (retrocalcaneal) or forefoot
- Tenderness that worsens with pressure or movement
- Warmth or redness in the affected area
- Pain that increases with walking, standing, or wearing tight shoes
- Stiffness in the surrounding joint or tendon (e.g., Achilles tendon)
Diagnosis
- Physical exam: Palpation reveals a tender, swollen area near the heel or between the metatarsals
- History: Symptoms are often worsened by specific footwear or activities
- Ultrasound or MRI: Used to confirm fluid accumulation and rule out tendon tears or other causes
- X-rays: May help exclude bone abnormalities (like Haglund’s deformity) or arthritis
Treatment
Conservative Options:
- Footwear changes: Switching to open-heeled or cushioned shoes to reduce irritation
- Padding or heel lifts to offload pressure from the back of the heel
- NSAIDs for pain and inflammation
- Ice and rest to reduce swelling
- Physical therapy: Stretching tight structures (like the calf muscles), correcting biomechanics, and strengthening
Interventional Options:
- Corticosteroid injections for persistent inflammation
Surgical Options:
- Surgery is rarely necessary but may be considered in chronic or recurrent cases unresponsive to conservative care, such as bursa removal or bone spur resection
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