Today I want to talk to you about bursitis. In the cooler months people return to their shoes and boots and we will typically see an increase in footwear related conditions including bursitis. Foot bursitis is rarely discussed in comparison to muscle, tendon, and ligament ailments, but surprisingly is a very common cause of foot pain.
So what is a bursa?
A bursa is a small fluid-filled cushioning sac located near tendons, ligaments, skin, and muscles. The bursa works by protecting structures that would otherwise rub directly across the surface of a bone and cause damage or irritation. Still can’t quite picture it? Try to think of a bursa as a piece of glad wrap with a slimy egg white style of fluid in it.
Healthy normal bursae allow for a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, movement relying upon the inflamed bursa becomes difficult and can be very painful. Additionally, movement of tendons and muscles over the inflamed bursa aggravates its inflammation and perpetuating the problem.
The bursae (plural for bursa) are very important to prevent friction, absorb shock, and decrease the wear and tear between moving structures. There are multiple bursae located in the forefoot area. The metatarsal bursae are located on the bottom of the foot near the base of the toes. Metatarsal bursitis commonly affects the second metatarsal head (the toe next to the big toe) but can also affect the tiny bursae located between the metatarsal bones which are known as intermetatarsal bursae. If these bursae become inflamed or irritated this is called intermetatarsal bursitis.
What can cause bursitis?
Bursitis in the foot may occur in several ways. It may present after direct trauma to the foot falls, slips, auto accidents, and sport-related impacts. However, the cause of bursitis in the forefoot is predominantly due to irritation from repetitive use and overuse, such as during prolonged standing or running. Direct pressure applied to an area over a bursa, such as from wearing boots that are too tight, may also be a causative factor. Certain foot and gait abnormalities, such as an abnormal toe joint, over pronation, flat feet, bunions, or hammer toes, can place additional stress on the bursa and lead to bursitis.
Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the tissues and structures running between the metatarsal heads. This chronic pinching can create a bursa to protect the surrounding structures. By itself this is not a problem, however if the friction continues the bursa will enlarge and become more swollen and cause symptoms.
The type of shoes worn during high-impact running, walking, and jumping activities can play a role in foot bursitis since inappropriate footwear allows for an increase in the amount of shock the bursa must absorb. Obesity can also increase how much stress is placed on a bursa.
What are some of the symptoms I would have if I was suffering bursitis?
- Localised swelling, pain, tenderness, warmth, and redness
- Walking barefoot, wearing tight socks, wearing tight shoes, or any other action that increases pressure over the bursa may exacerbate pain
- Walking, running, and jumping motions may be especially painful
- Range of motion in the joint near the affected bursa may be limited
What can I do if I think I have bursitis?
Firstly you should try a few things yourself at home
- Wear shoes which are nice and broad at the forefoot
- Don’t lace the forefoot part of your shoe too tight
- Make sure your feet are in supportive shoes that do not squeeze your forefoot
- If possible, try to avoid shoes which taper towards a point
Bursae can also be treated with rest, ice, elevation. Since bursitis is caused by increased friction from surrounding structures, a compression would create more friction around the joint and is not a good idea.
If the above advice isn’t helping you manage the pain, the next step is to come and get it looked at by your podiatrist who will do a full assessment of your footwear and gait pattern. They may also want to check everything with an x-ray or ultrasound.
Their treatment may include
- Additional footwear advice
- Deflective padding in your shoes
- Dry needling/acupuncture
- Surgical referral
The earlier conservative treatment of foot bursitis takes place the better the outcome! If anything I have spoken about today is ringing a bell with you or someone you know, come in and have it checked out and we can go from there. Don’t forget to bring a pair of your joggers and/or work shoes.
Until next time,