Bursitis is the inflammation of the small fluid-filled pads, or bursae, that act as cushions among your bones and the tendons and muscles near your joints. Bursitis occurs when the bursa become inflamed, and often occurs in joints that perform frequent and repetitive motion.
The foot only contains one naturally occurring bursal sac between the Achilles tendon and the heel bone, which protects the Achilles from the pressure against the heel bone during ambulation. However, shoes may put pressure on this bursa. The bursa might also incur trauma from walking on hard ground. And, though they are not naturally occurring, bursa sacs can also form, and become inflamed, in other parts of the foot, including the bottom of the heel, and the metatarsal plate, the outside of the foot below the fifth toe, and so on.
There are a variety of treatments for bursitis of the heel. Bursitis on the bottom of your heel (which is called infracalcaneal bursitis) is common in heels with thinning fat pads. Gel heel cushions or custom made orthotics (that have a horse-shoe cut and extra foam in the heel) can be lifesavers in reducing the pain. For bursitis of the posterior heel (retrocalcaneal bursitis), try to avoid going barefoot and to reduce the stress on the Achilles tendon by not over flexing your heel – the tighter your Achilles becomes, the more you compress the bursa sacs of the posterior heel. Heel lifts can help this, or wearing shoes with elevated heels (note that this method is not sanctioning high heels, as high heels can provide little comfort or support and usually are tight in the areas where your bursitis is most inflamed). Products such as AirHeel made by Aircast can help massage the bottom and back of the heel, helping to decrease pain.
In addition to being aware of foot-wear and inserts, be sure to modify your activity level to reduce the pain initially. Taking non-steroidal anti-inflammatory drugs (NSAIDs) and icing twice a day for 20 minute periods can help reduce the swell that leads to heel pain. Cortisone injections (more powerful anti-inflammatory medications) can be considered if your symptoms are persistent. After the swelling and pain has receded, ask your podiatrist about working with a physical therapist to strengthen the affected area in order to avoid bursitis by using your muscles in a more safe and efficient manner.
If all these treatment methods fail, surgery may be the best option to excise a painful bursa (note that this is in rare cases). Consult Dr. Murray and Dr. Chang for the best treatment method for your individual needs.
There are a number of other common contributors to heel pain due to the nerves that are tightly packed in around your Achilles tendon and the calcaneus bone. The posterior tibial nerve runs from the back of your lower leg, around the inside of your arch and to the bottom of your foot. When it is compressed by all the other muscles, tendons, ligaments and bones in your lower leg, ankle and foot, the compression can cause a burning sensation, numbness in the first three toes, tingling at the base of the foot and the heel, and a whole lot of pain that is both localized and even shoots up the leg. This condition is called tarsal tunnel syndrome (TTS), or posterior tibial neuralgia. TTS often causes more prolonged discomfort than plantar fasciitis after periods of rest. This could be because the posterior tibial nerve is connected to the sciatic nerve that runs along your legs, hip and lower back. Also unlike plantar fasciitis, which often has a general point of pain, TTS does not usually cause pinpoint tenderness along the plantar fascia.
Tarsal tunnel syndrome [KB1] can be caused by a number of factors. Basically, anything that causes compression in this area, be it cysts, bone spurs, inflammation, or even swelling from an ankle sprain, can aggravate the posterior tibial nerve. Biomechanics may play a role in TTS, as an abnormal gait may aggravate the posterior tibial nerve. Again, because of the numerous contributors to TTS, it is essential to contact your podiatrist for a diagnosis that will detect the underlying causation of TTS.
Tarsal tunnel syndrome (TTS) has a number of treatment methods. First, slow down with exercising and find an exercise that does not aggravate the pain or numbness in your foot (swimming is usually a good option, and even aqua jogging if you have a hard time restraining yourself from running). Your podiatrist will prescribe anti-inflammatory medications (NSAIDs, such as Ibuprofen, Advil or Motrin) to reduce the inflammation and alleviate your heel pain. Cortisoid injections might be helpful for some conditions. Key to treatment, however, will be making sure that your arch is supported, as rigid arch supports have been shown to help those with TTS. Over the counter and custom orthoticscan help relieve symptoms, and making sure your everyday and athletic footwear are the right size for you, supportive of your foot, and not too worn out will be key in tackling the problem long term. Working with a physical therapist will help you find stretches and massage techniques to lessen the compression causing your TTS.
If no other treatment strategies help, your podiatrist may suggest a surgery called “tarsal tunnel release.” This surgery will decrease pressure on the posterior tibial nerve by releasing the lacinate ligament, an exploration of the tarsal canal and decompression of the posterior tibial nerve. Note that surgery requires a recovery period of three to eighteen months depending on the procedure, so it is important that you work dedicatedly with your podiatrist on other treatment methods for some time before you and your doctor decide that surgery is the best option for you.