Bursitis is a common orthopedic condition resulting from the inflammation of a bursa, a small, fluid-filled sac found throughout the body. These sacs function as cushions, reducing friction between bones, tendons, and muscles near joints during movement. Bursitis can occur in the ankle and heel area, causing localized pain, swelling, and difficulty with mobility. The presence of bursae in the ankle, particularly near the Achilles tendon, makes this region susceptible to irritation from overuse or pressure.
Ankle Bursitis Locations and Types
The ankle and heel region contains several bursae, but two types of bursitis are most frequently diagnosed at the back of the heel. Retrocalcaneal bursitis involves the bursa located deep, or anterior, to the Achilles tendon and situated against the heel bone, known as the calcaneus. This bursa minimizes friction between the strong Achilles tendon and the bony prominence of the heel during activities like walking or running.
A second common type is subcutaneous calcaneal bursitis, also referred to as Achilles bursitis. This involves the bursa positioned superficially, or posterior, between the skin and the Achilles tendon. This superficial bursa acts as a protective pad against external pressure, often from the rigid back of a shoe. Retrocalcaneal bursitis is frequently associated with Haglund’s deformity, a bony enlargement on the heel that impinges on the bursa, especially during ankle dorsiflexion.
Distinguishing Symptoms and Causes
Ankle bursitis is characterized by several localized symptoms that help distinguish it from other foot and ankle issues like tendonitis. Individuals typically experience a soft, visible swelling or lump, often described as puffy, in the area of the inflamed bursa. This swelling is usually accompanied by localized pain and tenderness when the affected area is touched or when pressure is applied, such as while standing or walking. The skin over the bursa may also appear warm and red, indicating an active inflammatory process.
The underlying causes of ankle bursitis are often mechanical, involving repetitive friction or direct trauma to the area. Repetitive motions common in athletes, such as running or jumping, can irritate the bursae due to overuse. Ill-fitting or rigid footwear, including ski boots or certain dress shoes with a restrictive heel counter, can cause excessive pressure and lead to inflammation. Furthermore, systemic inflammatory conditions, such as gout or rheumatoid arthritis, can increase the likelihood of developing bursitis.
Non-Surgical Treatment Approaches
Initial management of ankle bursitis focuses on conservative, non-surgical treatment approaches aimed at reducing inflammation and relieving pain. One of the most common first-line strategies is the application of the R.I.C.E. protocol, which stands for Rest, Ice, Compression, and Elevation. Resting the ankle involves avoiding activities that exacerbate the pain, while applying ice to the area for 10 to 20 minutes several times a day helps minimize swelling and pain.
Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, can be taken to reduce both pain and the inflammatory response in the bursa. Adjusting footwear is also an important conservative step, which may involve switching to open-backed shoes or using heel lifts to alleviate pressure on the affected bursa. Physical therapy techniques can promote recovery, often including gentle stretching exercises for the Achilles tendon to improve flexibility and reduce tension on the posterior heel structures.
Advanced Medical Interventions
If conservative measures fail to resolve the bursitis, a physician may recommend more advanced medical interventions to manage persistent symptoms. Corticosteroid injections are a common next step, involving the injection of a powerful anti-inflammatory medication directly into the bursa. This injection can significantly decrease inflammation and pain, though it carries a small risk of complications, including potential damage to the adjacent Achilles tendon.
In cases where fluid accumulation is substantial or infection is suspected, the doctor may perform bursa aspiration. This procedure involves inserting a sterile needle to drain the excess fluid from the inflamed sac, which can immediately relieve pressure and allow for fluid analysis to check for infectious organisms. Surgical intervention, typically a bursectomy to remove the inflamed bursa, is generally reserved as a last resort for chronic or severe cases that have not responded to six months or more of non-operative treatment.