Foot Bursitis

Orthopedic surgeon specialized in foot care

Foot pain can have many origins, but one of the often overlooked causes remains bursitis. It frequently affects areas such as the heel, the base of the big toe, or even the back of the foot, impacting walking, wearing shoes, and sports activities.

In this article, The foot and ankle clinic offers an overview of the causes of foot bursitis, the symptoms you should be aware of, the available treatments, and best practices to prevent its onset or recurrence. Goal: to help you better understand this condition in order to act quickly and effectively.

What is bursitis?

Bursitis is therefore the inflammation of a synovial bursa, otherwise known as inflammatory bursitis. When a synovial bursa is overused or when it is trapped between a prominent bony projection and a rigid element, it becomes inflamed and the amount of fluid within the bursa increases. If the stress continues, the bursa will thicken and cause it to stick to the tissues it is meant to help glide. This sticking phenomenon due to thickening of the bursa is responsible for the pain.

What are the symptoms of bursitis?

The main symptoms of bursitis are:

The Different Types of Bursitis

There are several foot conditions in which bursitis can be described:

  • Hallux valgus: the prominence of the metatarsal head can become problematic when wearing shoes, causing compression of the bursa between the metatarsal head and the shoe, leading to a bursitis visible as a red spot on the medial edge of the foot.
  • Morton's neuroma: bursitis is a sonographic or MRI sign corresponding to an increase in tissue volume in the affected space, usually the third intermetatarsal space.
  • Metatarsalgias: when there is pain in the plantar pads, a plantar bursitis is often described on imaging.
  • Bunionette: the prominence of the 5th metatarsal head can become problematic when wearing shoes, causing compression of the bursa between the metatarsal head and the shoe, leading to a bursitis visible as a red spot on the lateral edge of the foot.

At the knee, it is possible to observe a bursitis in front of the kneecap, known as pre-patellar, especially in cases of trauma due to direct impact on the kneecap.

Bursitis at the level of the tendon can be pre- and/or retro-Achillean.

  • Pre-Achillean bursitis is clinically visible in cases of Haglund-type conflict, and is responsible for fluctuating swelling at the level of the posterior process of the calcaneus.
  • Retro-Achillean bursitis is also observed in Haglund-type conflicts but also in cases of chronic calcifying Achilles tendon insertion tendinopathy.

At the hip, inflammation or injury of the gluteal tendon insertion on the greater trochanter is responsible for pain.

At the shoulder, subacromial impingement is responsible for a bursitis causing a painful subacromial catching sensation.

What are the possible treatments?

Symptomatic treatment is undertaken in the case of painful bursitis, consisting of taking painkillers and anti-inflammatories. It is necessary to modify the factors that promote bursitis:

If the medical treatment fails, surgical treatment may be proposed to address the cause of the bursitis.

What operations are possible?

Surgical procedures make it possible to correct the cause of bursitis. Corrective osteotomies, which involve cutting a bone to change its anatomy, can be used to correct a hallux valgus or a bunionette.

Osteotomies are also used in cases of metatarsalgia to restore the relative length of the metatarsals or to raise them when there is atrophy of the plantar fat pad. Removing a Morton’s neuroma eliminates bursitis in the corresponding space.

Shaping osteotomy or calcaneoplasty is used in addition to bursa resection, called bursectomy, in Haglund's disease. In cases of insertional calcaneal tendinopathy resistant to medical treatment, a calcaneal osteotomy may be recommended, or detachment and reattachment of the Achilles tendon may be performed depending on the anatomical conditions.

FAQ

There is no time limit for bursitis. When bursitis has lasted for less than 6 months, it is considered acute bursitis; beyond 6 months, it is considered chronic bursitis. Surgical correction of the anatomical factors responsible for bursitis can eliminate it.

Painkillers and anti-inflammatory drugs are used as first-line treatment. Changing footwear habits and wearing orthopedic insoles may be recommended depending on the cause of the bursitis. Surgical treatment allows for the correction of an anatomical deformity responsible for the bursitis.

Bursitis is an inflammation of a tissue sliding bursa that is compressed between an anatomical prominence and a hard surface. Eliminating the compression can reduce bursitis when it is not chronic.