Heel bursitis describes the inflammation of a bursa located around the heel bone. A bursa is a small, fluid-filled sac that acts as a cushion between bones, tendons, and muscles, reducing friction during movement. In the heel, the retrocalcaneal bursa is commonly affected, situated between the Achilles tendon and the heel bone, or calcaneus. This condition can lead to pain and discomfort, often making walking or standing challenging. This article explores managing heel bursitis, from self-care to medical interventions and prevention.
Initial Self-Care Approaches
Self-care measures can alleviate heel bursitis symptoms. Rest the affected heel by reducing activities that aggravate pain, such as running or prolonged standing. Apply ice to the inflamed area for 15 to 20 minutes several times daily to reduce swelling and pain. Wrapping the heel with an elastic bandage provides compression, minimizing swelling, but avoid applying too tightly. Elevating the foot above heart level helps decrease fluid accumulation and swelling.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can manage pain and inflammation; always follow dosage instructions. Choose appropriate footwear with good arch support and cushioning to reduce heel pressure. Avoid flat shoes or high heels, which can worsen the condition. Inserting heel cups or soft padding provides additional cushioning and support, redistributing pressure away from the inflamed bursa. Gentle stretching exercises for the Achilles tendon and calf muscles improve flexibility and reduce tension.
When to Consult a Doctor
While self-care is often effective, professional medical advice is sometimes necessary. Consult a doctor if heel pain worsens or does not improve after several days of consistent self-care. Severe pain that significantly interferes with daily activities, such as walking or sleeping, also indicates a need for professional evaluation.
Signs of potential infection, such as redness, warmth, increased swelling around the heel, or a fever, warrant an immediate doctor’s visit. Inability to bear weight on the affected foot or numbness/tingling sensations in the foot or toes suggest a more serious issue requiring professional diagnosis.
Professional Medical Interventions
When self-care is insufficient, healthcare professionals offer various medical interventions. Diagnosis typically begins with a physical examination of the foot and ankle to assess tenderness and range of motion. Imaging tests, such as X-rays, may rule out other conditions like stress fractures or bone spurs. An MRI might visualize soft tissues like the bursa and tendons more clearly.
Prescription medications may include stronger doses of NSAIDs to control inflammation and pain. If infection is suspected, antibiotics will be prescribed. Corticosteroid injections directly into the bursa can provide powerful anti-inflammatory effects and significant pain relief. These injections are generally not a long-term solution and are typically limited in frequency due to potential side effects like temporary pain worsening (cortisone flare), skin discoloration, or, rarely, tendon weakening.
Physical therapy plays a significant role in rehabilitation, focusing on specific exercises to strengthen surrounding muscles and improve flexibility. Therapists may use modalities like ultrasound or electrical stimulation to reduce pain and inflammation. They can also perform gait analysis to identify and correct biomechanical issues. If the bursa is significantly swollen, aspiration may drain excess fluid, relieving pressure and pain. Surgery, known as a bursectomy, is a last resort for chronic cases unresponsive to other treatments, involving removal of the inflamed bursa.
Strategies for Prevention
Preventing heel bursitis recurrence involves adopting several long-term strategies to reduce stress on the heel. Choose appropriate footwear with adequate cushioning, arch support, and a proper fit for daily activities and sports. Using orthotics or custom-made shoe inserts can help correct biomechanical imbalances and provide additional support, reducing heel pressure.
Gradually increase activity levels, particularly when starting a new exercise regimen, to avoid sudden stress on the heel. Incorporate regular stretching routines for the Achilles tendon and calf muscles to maintain flexibility and prevent tightness. Maintaining a healthy weight reduces overall load on the feet and ankles. Perform proper warm-up exercises before physical activity and cool-down stretches afterward. Listen to your body and address early signs of discomfort to prevent minor irritation from escalating into full-blown bursitis.