Bursitis of the foot

What is bursitis of the foot?

Bursitis of the foot is inflammation of a bursa: a small fluid-filled sac that cushions the space between bone and muscle, tendon or skin¹. There are several in the foot and ankle. One sits at the back of the heel, between your Achilles tendon and heel bone, and inflammation there is called retrocalcaneal bursitis². Others can form over the ankle bones³ and between the long bones at the ball of your foot⁴. A bursa can sometimes become infected¹.

What causes it, and who gets it?

Foot bursitis is mainly a friction problem. It usually develops slowly from repeated rubbing and strain, for example during running and walking, rather than from one injury². At the heel, common risk factors are a sharp increase in activity, tight shoes that press on the back of the heel, and a Haglund's bump (a change in the shape of the heel bone)². At the forefoot, tight or high-heeled shoes can irritate the bursa⁴.

Less often, crystal deposits or autoimmune conditions such as rheumatoid arthritis play a part³. Infection usually follows a skin injury or a skin infection nearby³.

What does it feel like, and how is it diagnosed?

Bursitis usually causes pain in one spot, with swelling, redness or warmth³. At the back of the heel you may also have pain when you push up onto your toes, and a limp².

A podiatrist or doctor can usually diagnose it from your story and an examination. Scans aren't usually needed, though one may be suggested if it isn't improving, or before an injection or surgery². It helps to note where it hurts and what makes it worse. Heel pain has look-alikes, including Haglund's syndrome (heel pain linked to a bump on the heel bone), insertional Achilles tendon problems and plantar fasciitis⁵, so it's worth having it assessed rather than assuming it's bursitis.

What helps first?

Most bursitis settles with simple, non-surgical care, and almost every case of heel bursitis gets better this way². Self-care comes first:

• Ease off what hurts. Cut back on the activities that hurt most, and avoid high-impact activity such as running and jumping for now².
• Take pressure off. Choose supportive, roomy shoes. At the heel, avoid very hard heel areas, very flat shoes and high heels². For the forefoot, a wider toe box and thicker sole can help⁴.
• Ice it. The Try this box below shows how.
• Ask about pain relief. Paracetamol or ibuprofen can ease the pain⁶. A pharmacist or your GP can tell you what suits you, especially if you have other health conditions.

These steps are widely recommended, but how much each one helps foot bursitis isn't clear yet. Give them 1–2 weeks. If you're not improving, see your GP or a podiatrist⁶.

What helps if that isn't enough?

A GP or podiatrist can talk through next steps with you. The options are a steroid injection and, rarely, surgery.

A steroid injection near the Achilles tendon carries some risk of tendon tear or rupture, so it's generally kept as a last resort². How much an injection helps bursitis caused by repeated friction isn't clear yet⁷. If one is suggested, it's reasonable to ask about the risk to your Achilles tendon and whether a scan is needed first.

Surgery is needed only in resistant cases of Haglund's syndrome⁵. If the bursa is infected, it needs medical treatment, usually with antibiotics⁷.

How long does it take, and how do I stop it coming back?

The outlook is generally good, because almost all heel bursitis improves with non-surgical care². How long it takes isn't clear yet, so review your progress after 1–2 weeks⁶. Carrying on with the activity or shoes that cause the rubbing is a likely reason it lingers².

To help keep it from coming back:

• Build up running or walking gradually rather than sharply².
• Keep wearing roomy, supportive shoes after the pain settles, and avoid tight or high-heeled shoes²⁴.
• Check whether your shoes press on the back of your heel or squeeze your forefoot.