In the foot we have a unique situation in that between the shoes that we wear and the ground that we walk on various parts of the foot are constantly being ?micro? traumatized meaning that every time we take a step we do a small amount of damage to a particular part of the foot and eventually that part of the foot begins to hurt. The body?s response to this micro-trauma is to create a bursal sac to initially protect the area but if micro-traumatized enough the bursal sac itself becomes inflamed and we have a bursitis.
Bursitis occurs when the bursae become irritated or infected, often causing pain on movement. When infection is involved, medical intervention is necessary to fight the underlying infection and prevent it from spreading, when infection is not involved, prompt medical attention can prevent the condition from becoming worse over time.
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.
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
Long Term Treatment must be directed towards eliminating the abnormal tilting of the heel, regardless of its cause. If this is delayed, the usual results are the pain and swelling becomes worse, chronic, and debilitating. Eventually, painful calcifications and bone spur formations may occur on the back of the heel, along with tears in the Achilles Tendon. These are serious problems that may require surgical intervention. In order to eliminate abnormal heel tilt, the foot must be re-balanced. Controlling and reducing the biomechanical foot defects that are causing the heel to tilt best accomplish this. The "Gold Standard" of medical care (that treatment most used by doctors and therapists) to help eliminate pain, inflammation, and swelling at the back of the heel is orthotics.
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.
Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.