Bursitis Of The Foot Bursa Removal Complications

posted on 25 Aug 2015 22:27 by despinahasbni
Overview

Bursitis occurs when a bursa is irritated from frequent pressure and it becomes inflamed. Due to the location close the Achilles tendon, Achilles bursitis is often mistaken for tendinitis. Achilles bursitis is a common overuse injury in runners, ice skaters and other athletes.

Causes

Wearing poorly fitting or constrictive footwear can cause the heel to become irritated and inflamed. Shoes that dig into the back of the heel are the primary cause of retroachilles bursitis. Foot or ankle deformity. A foot or ankle deformity can make it more likely to develop retrocalcaneal bursitis. For example, some people can have an abnormal, prominent shape of the top of their heel, known as a Haglund's deformity. This condition increases the chances of irritating the bursa. A trauma to the affected heel, such as inadvertently striking the back of the heel against a hard object, can cause the bursa to fill with fluid, which in turn can irritate and inflame the bursa's synovial membrane. Even though the body usually reabsorbs the fluid, the membrane may stay inflamed, causing bursitis symptoms.

Symptoms

Pain at the back of the heel, especially when running uphill. Pain may get worse when rising on the toes (standing on tiptoes). Tenderness at the back of heel. Swelling at the back of heel.

Diagnosis

The doctor will discuss your symptoms and visually assess the bones and soft tissue in your foot. If a soft tissue injury is suspected, an MRI will likely be done to view where and how much the damage is in your ankle. An x-ray may be recommended to rule out a bone spur or other foreign body as the cause of your ankle pain. As the subcutaneous bursa is close to the surface of the skin, it is more susceptible to septic, or infectious, bursitis caused by a cut or scrape at the back of the heel. Septic bursitis required antibiotics to get rid of the infection. Your doctor will be able to determine whether there is an infection or not by drawing a small sample of the bursa fluid with a needle.

Non Surgical Treatment

Treatment is primarily comprised of relief from the painful activity (running). It is important that shoes do not pinch the heel. If satisfactory progress is not made during the rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the bursa. Injections should be performed under ultrasound guidance to ensure optimal effect and reduce the risk of injecting into the Achilles itself. If progress is not made neither through rehabilitation nor medicinal treatment, surgical treatment can be attempted.

Surgical Treatment

Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

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