Foot bursitis is an inflammation of one of the synovial bags (burs) of the foot. Bursae located in the area of the I metatarsophalangeal joint, Achilles tendon and the lower surface of the calcaneus are more often affected. It is manifested by pain and swelling of soft tissues. Local hyperemia is possible. When infected, the pain becomes more intense, symptoms of general intoxication are added. The course is usually chronic, although there are also acute forms. Diagnosis is made on the basis of the clinical picture, radiography, MRI and CT data. Conservative treatment: load restriction, NSAIDs, physiotherapy, blockades, wearing orthopedic shoes. In some cases, operations are performed to eliminate concomitant pathology.
ICD 10
M76.6 M20.1
Meaning
Foot bursitis is a group of inflammatory diseases in which one of the synovial bags located on the foot is affected. Bursitis in the Achilles tendon (achillobursitis), the lower surface of the calcaneus (subcutaneous bursitis) and the I metatarsophalangeal joint (I toe bursitis) are more often inflamed. Foot bursitis is often combined with other pathological conditions (Hallux valgus – valgus deformity of the I metatarsophalangeal joint, plantar fasciitis, heel spur). Usually middle-aged and elderly people suffer, the exception is achillobursitis, which is often detected in athletes. Orthopedic traumatologists are engaged in the diagnosis and treatment of foot bursitis.
Causes
The cause of the development of foot bursitis is usually repeated microtrauma due to excessive physical exertion and / or various pathological conditions accompanied by a violation of the biomechanics of the foot (flat feet, clubfoot, hallux valgus, etc.). Predisposing factors are overweight, aging of the body, a decrease in the thickness of the subcutaneous fat layer at the locations of the bursa, arthrosis of nearby joints, wearing uncomfortable shoes, as well as spinal pathology, as a result of which there is a redistribution of the load on the foot (posture disorders, Sheyerman-Mau disease, lumbosacral osteochondrosis, etc.). In addition in addition, in some cases, foot bursitis develops with rheumatoid diseases and metabolic diseases (for example, gout). In the latter case, the cause of foot bursitis is the deposition of salts in the tissues of the synovial sac.
Pathanatomy
Bursa or synovial sac is a hollow anatomical formation in the form of a pouch with a small amount of fluid. Bursae are located near the joints, in places subject to the greatest pressure and friction. Their purpose is to protect soft tissues. With inflammation (bursitis), the inner shell of the bursa begins to secrete a large amount of fluid, and the bag increases in volume. This process is accompanied by other inflammatory manifestations: pain and swelling of the surrounding soft tissues. Usually, foot bursitis has an aseptic character, that is, it proceeds without the participation of microbial agents and the formation of pus. Despite this, the pain syndrome with foot bursitis can be very intense, due to irritation of the synovial sac during movements and a significant load on inflamed tissues when resting on the foot.
Types of foot bursitis
Bursitis of the I metatarsophalangeal joint
Foot bursitis in this area usually develops with valgus deformation of the I metatarsophalangeal joint. Due to the weakness of the transverse ligaments of the foot, the joint gradually “bends” at an angle open towards the V finger. Increased pressure and friction in the joint area causes permanent traumatization of soft tissues. The skin turns red, thickens, corns and corns appear in places of the greatest pressure. The synovial sac becomes inflamed, which, along with skin irritation and the development of arthrotic changes in the joint, causes the development of pain syndrome.
Initially, the patient is concerned about pain after a long walk and wearing uncomfortable shoes. Then the pain syndrome becomes more intense, occurs after a slight load or at rest, including at night. The examination reveals the flatness of the foot and a visible deformation in the area of the I metatarsophalangeal joint – a bone “bump” surrounded by compacted soft tissues. The I finger is located at an angle to the rest, and in some cases “lies” on the II finger. With palpation and movements, indistinct soreness is determined, the pain increases with maximum back flexion. Movement restriction is possible. To clarify the diagnosis, radiography of the foot, CT and MRI of the foot are prescribed.
In the early stages, the treatment is conservative. The patient is recommended to wear wide shoes with low heels, use special insoles and inserts and perform exercises to strengthen the foot. In the period of exacerbation, nonsteroidal anti-inflammatory drugs of local and general action, UHF and magnetotherapy are prescribed. In the remission phase, the patient is referred for inductothermy, ozokerite, paraffin, electrophoresis with novocaine or phonophoresis with hydrocortisone. With pronounced deformation, corrective operations are performed.
Achillobursit
Achillobursitis is an inflammation of the synovial sac located on the back surface of the heel, in the area of attachment of the Achilles tendon. Due to excessive loads, the disease usually occurs in athletes and overweight people (obesity). Patients are concerned about pain in the heel bone and the posterior surface of the lower leg. The pain increases in the morning and when trying to “stand on your toes”. On examination, edema and local hyperemia are detected on the back surface of the heel. Palpation is painful. Movement is limited due to pain.
The diagnosis is made on the basis of clinical symptoms. If necessary, radiography and MRI of the ankle joint are prescribed. If metabolic disorders and endocrine diseases are suspected (usually in overweight patients), an endocrinologist’s consultation and a more detailed examination, including biochemical blood tests and other studies, are indicated. Treatment of foot bursitis is conservative, includes NSAIDs of general and local action, phonophoresis with hydrocortisone, electrophoresis with novocaine, UHF, paraffin and ozokerite. With intense pain syndrome, blockades with hydrocortisone are performed. The patient is recommended to limit the load, wear comfortable shoes, use special pads or put a soft cloth under the affected area.
Subcutaneous bursitis
Subcutaneous foot bursitis is combined with plantar fasciitis and heel spur. Plantar fasciitis is an inflammation of the fascia of the foot that occurs due to its lack of elasticity in combination with significant loads (prolonged running in athletes, prolonged walking or constant standing in people of certain professions). Due to the lack of elasticity in the fascia tissue, microfractures occur. The inflammatory process spreads to the synovial sac located on the lower surface of the calcaneus. Over time, a bone outgrowth – a heel spur – forms in the area of the greatest soreness.
A patient with foot bursitis is concerned about pain in the heel area when supporting and walking. The pain occurs unexpectedly, for no reason, can be very intense (patients compare it with a nail embedded in the heel) and is usually localized along the plantar surface of the foot, slightly distal to the heel bone. The initial nature of the pain is noted – the pain syndrome reaches a maximum during the first steps after sleep or rest. Then the patient “walks around”, and the pain decreases, but may increase again in the evening, after stopping walking.
Podpyatochny foot bursitis has a chronic course, lasts for several years and causes significant inconvenience to the patient. At the height of the pain syndrome, the patient loses the ability to lean on the heel, which significantly complicates standing and walking, especially with bilateral bursitis of the foot. After some time after the formation of the heel spur, the pain decreases and gradually disappears. The diagnosis is made on the basis of complaints, examination data, results of radiography of the calcaneus, MRI of the foot and ultrasound of the foot. It should be borne in mind that the severity of radiological changes does not always correlate with the intensity of the pain syndrome. Both sharp pains with a normal X-ray picture and mild soreness in the presence of a formed heel spur are possible.
Treatment is conservative. The patient is recommended to wear orthopedic insoles, foot pads or special orthopedic shoes. Prescribe warm baths with sea salt, exercise therapy, electrophoresis with novocaine, phonophoresis with hydrocortisone, ozokerite and paraffin. With severe pain syndrome, blockades with hydrocortisone are carried out.
