Bursitis Feet Pads

Overview

Bursae are situated in various locations throughout the body where friction between tissues commonly occurs. These sacs are designed to help reduce friction and prevent pain. Repetitive movements or prolonged and excessive pressure are the most common causes of bursal inflammation, though traumatic injury may also cause this painful problem. In fact, the body sometimes creates bursal sacs in response to trauma or tissue damage.

Causes

Bursitis has many causes, including autoimmune disorders, crystal deposition (gout and pseudogout), infectious diseases, traumatic events, and hemorrhagic disorders, as well as being secondary to overuse. Repetitive injury within the bursa results in local vasodilatation and increased vascular permeability, which stimulate the inflammatory cascade.

Symptoms

Your feet are extremely resilient and are designed to stand up to the pressures of day-to-day living. In some cases, though, foot structures may break down when subjected to chronic stress associated with prolonged periods of weight-bearing activity on concrete, asphalt, or other hard surfaces (especially when your footwear does not allow for appropriate weight distribution). Foot problems, including infracalcaneal bursitis, are often exacerbated by poorly designed footwear, and pressure, impact, and shear forces can damage your feet over time. Bursal sacs are intended to minimize this damage, but sometimes the bursa itself becomes inflamed.

Diagnosis

Obtaining a detailed history from the patient is important in diagnosing calcaneal bursitis. The following complaints (which the physician should ask about during the subjective examination) are commonly reported by patients.

Other inquiries that the physician should make include the following. The clinician should ask about the patient's customary footwear (whether, for example, it includes high-heeled shoes or tight-fitting athletic shoes). The patient should be asked specifically about any recent change in footwear, such as whether he/she is wearing new athletic shoes or whether the patient has made a transition from flat shoes to high heels or vice versa. Individuals who have been accustomed to wearing high-heeled shoes on a long-term basis may find that switching to flat shoes causes increased stretch and irritation of the Achilles tendon and the associated bursae. The specifics of a patient's activity level should be ascertained, including how far the patient runs and, in particular, whether the individual is running with greater intensity than before or has increased the distance being run. The history of any known or suspected underlying rheumatologic conditions, such as gout, rheumatoid arthritis, or seronegative spondyloarthropathies, should be obtained.

Non Surgical Treatment

Caregivers may give you special shoe inserts with a cutout around the tender area. You may also be told to wear shoes with a reinforced heel counter. This will give better heel control. You may need other shoe inserts (wedges) to raise your heel so it does not press against the back of the shoe. You may also wear shoes that are open in the back, such as sandals that have no strap across the heel. You may use ibuprofen (eye-bu-PROH-fen) and acetaminophen (a-seet-a-MIN-oh-fen) medicine for your pain. These may be bought over-the-counter at drug or grocery stores. Do not take ibuprofen if you are allergic to aspirin. You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your ankle is healed and that you can return to heavy exercise. It is important to not exercise until your caregiver says it is OK. You could make the bursitis worse if you exercise too soon. You may need surgery to remove the bursa or part of your ankle bone. Surgery is usually not necessary unless the bursitis is very bad and does not heal with other treatments. Your caregiver may want you to go to physical (FIZ-i-kal) therapy (THER-ah-pee). Physical therapists may use ultrasound to increase blood flow to the injured area. Caregivers may use massage to stretch the tissue and bring heat to the injury to increase blood flow. These and other treatments may help the bursitis heal faster. Exercises to stretch your Achilles tendon and make it stronger will be started after the bursitis has healed. You may gradually increase the amount of weight you put on your foot when caregivers say it is OK. You may be told to stop exercising if you feel any pain.

Surgical Treatment

Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to remove the inflamed bursa.

Prevention

Maintain proper form when exercising, good flexibility, and strength around the ankle to help prevent this condition from arising. Proper stretching of the achilles tendon helps prevent injury.

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