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Ankle bursitis

What is it?

Bursitis (ber-SEYE-tis) is swelling and pain of a bursa. A bursa is a fluid-filled sac that acts as a cushion or shock absorber between a tendon and a bone. A tendon is a cord of tough tissue that connects muscles to bones. Normally a bursa has a small amount of fluid in it. When injured, the bursa becomes inflamed (red and sore) and may fill with too much fluid. Achilles (ah-KIL-eez) tendon bursitis is a type of ankle bursitis when the bursa between the Achilles tendon and the heel becomes inflamed. You may have Achilles bursitis and tendonitis (inflamed tendon) at the same time.

Causes:

Your ankle bursitis may have been caused by one or more of the following:

  • Pressure on your ankle and heels. This is often caused by running or exercising on uneven ground. The way that you exercise may also cause ankle bursitis or make it worse. It may be caused by wearing poorly fitting shoes that constantly rub against the heel.
  • Direct, hard hit to your heel.
  • Infection (in-FEK-shun).
  • Medical problems such as rheumatoid (ROO-ma-toid) arthritis (ahr-THREYE-tis) or gout.
  • Overusing your ankles. This is caused by doing activities or sports that use the same motions (movements) over and over again. Examples of repeating motions are running, walking, or jumping.
  • Sometimes people do not know how they developed ankle bursitis.

Signs and Symptoms:

  • Limping.
  • Decreased movement. Your ankles may feel stiff or unable to move as well as they usually do.
  • Pain or tenderness in the back of the ankle. It may be worse at the beginning of exercise, or when running uphill. You may also have pain when wearing shoes.
  • Redness and warmth. If the bursa is infected, the skin over the heel may be red and warm. You may also have a fever.
  • Swelling on the back of the heel.

Wellness Recommendations:

  • The most important part of treating bursitis is resting your Achilles tendon while the bursa heals. Resting your ankle as much as possible may decrease swelling and keep the bursitis from getting worse. When the pain decreases, begin normal, slow movements.
  • Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this on your heel for 15 to 20 minutes, three to four times each day. Do not sleep on the ice pack because you can get frostbite.
  • After two or three days, you may try using heat to decrease pain and stiffness. Use a hot water bottle, heating pad, whirlpool or warm, moist compress. To make a compress, dip a clean washcloth in warm water. Wring out the extra water and put it on your heel for 15 to 20 minutes, three to four times each day. Your caregiver may tell you to switch between treating your heel with ice packs and heat treatments. Follow the caregiver's directions carefully when doing these treatments.

Medical Care:

  • 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.

Following are things you can do to help prevent bursitis from returning:

  • Do not run if you have pain. When you begin running again, avoid running fast uphill or downhill until the tendon is fully healed.
  • Start exercising when caregivers say that it is OK. Slowly start exercise such as bicycling when caregivers say it is OK. When doing exercises that put pressure on the ankles, such as running or walking, exercise on flat, even surfaces. Avoid doing these exercises on very hard surfaces such as asphalt or concrete.
  • Stretch before exercising. Always warm up your muscles and stretch gently before exercising. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your heel.
  • Wear heel protectors. Use soft foam or felt heel pads (wedges or cups) to help decrease pressure against your heel. Ask your caregiver which heel pads are the best for you.
  • Wear well-fitting shoes. Buy running or exercise shoes that support and fit your feet well. Do not wear low-cut shoes. Talk to your caregiver or go to a special exercise footwear store to get well-fitting athletic shoes. Ask your caregiver if you should wear specially-made shoe inserts called orthotics (or-THOT-iks). Orthotics can line up your feet in your shoes to help you run, walk and exercise correctly.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Boswellia (Boswellia s errata) has been used for many years, but has not been studied in people who have bursitis.
  • Capsaicin creams (Capsicum frutescens) , made from the cayenne pepper, may help pain when applied to the affected area. Wash your hands after using the cream so that it does not get into your eyes.
  • Turmeric (Curcuma longa) has been used for many years, but has not been studied in people who have bursitis.
  • Willow (Salix alba) has been used for many years, but has not been studied in people who have bursitis.

Supplements:

  • Bromelain has been used, but has not been studied in people with bursitis.
  • DMSO (dimethyl sulfoxide) has been used, but has not been studied in people with bursitis. Do not use DMSO longer than 14 days as it may cause eye problems.
  • D-phenylalanine has been used, but has not been studied in people with bursitis.
  • Niacinamide has been used, but has not been studied in people with bursitis.

Complementary Therapies:

  • Acupuncture may decrease bursitis inflammation.

Other ways of treating your symptoms : Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat bursitis.
  • Your symptoms have not gone away or improved by these self-help measures.
  • Your pain and swelling increase.
  • You develop new, unexplained symptoms.
  • You have questions about what you have read in this document.

Care agreement: You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. American Academy of Orthopaedic Surgeons: What are NSAIDs? December 2002. Available at: http://orthoinfo.aaos.org (cited 3/1/04).

2. Arthritis Foundation. Bursitis, tendinitis and other soft tissue rheumatic syndromes (online brochure). September 26, 2003. Available at: http://www.arthritis.org/AFStore/singleproduct.asp?idproduct=3320&idcat=8 (cited 3/4/04).

3. Ceccherelli F, Gagliardi G, Matterazzo G et al: The role of manual acupuncture and morphine administration on the modulation of capsaicin-induced edema in rat paw: a blind controlled study. Acupunct Electrother Res 1996; 21(1):7-14.

4. Mayo Foundation for Medical Education and Research. Bursitis. December 18, 2003. Available at: http://images.mayoclinic.com/invoke.cfm?id=DS00032 (cited 3/2/04).

5. Mayo Foundation for Medical Education and Research. Injections. November 19, 2002. Available at: http://www.mayoclinic.com/invoke.cfm?id=PN00046 (cited 3/1/04).

6. Mazzone MF, McCue T. Common conditions of the Achilles tendon. Am Fam Physician (serial online). May 1, 2002; 65(5):1805-1810. Available at: http://www.aafp.org/afp/20020501/1805.html (cited 3/9/04).

7. Pinter E & Szolcsanyi J: Systemic anti-inflammatory effect induced by antidromic stimulation of the dorsal roots in the rat. Neurosci Lett 1996; 212(1):33-36.

8. Richards CF, Koutouzis TK. Tendonitis and bursitis. In: Marx JA, Hockberger RS, Walls RM, Adams J, Barkin RM, Barsan WG et al (eds). Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed. St. Louis, MO; 2002:1599-1607.

9. Schoen AM: Acupuncture for musculoskeletal disorders. Probl Vet Med 1992; 4(1):88-97.

10. Zhang WY & Li Wan Po A: The effectiveness of topically applied capsaicin: a meta-analysis. Eur J Clin Pharmacol 1994; 46(6):517-522.


Last Updated: 6/16/2017
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