Ankle Bursitis

Ankle bursitis is a painful condition that is the result of one or more of the bursa of your ankle becoming irritated and inflamed. This can happen through overuse over an extended period or it can be the result of a blow to the ankle. It can also be the result of pressure on a particular spot on your ankle from poorly fitting shoes.

People with bursitis in the ankle suffer from pain and inflammation in the joint, often at or near the heel.The pain often increases during activity.

The typical treatment for ankle bursitis involves resting the joint so that the inflamed bursae recover naturally.

Ankle Bones & Bursae

The ankle is the junction of four different foot bones. One of these bones is the ankle bone itself, called the talus. If you are wearing a pair of lace up shoes, the talus would be located near the top of the laces.

The top of the talus is enclosed by the lower foot bones  – the tibia (shin bone) and the fibula (situated just outside the tibia). Finally, the bottom of the talus fits into the fourth bone – the calcaneous or heel bone.

The ankle bursa is a fluid filled sac that reduces friction between ankle tendons and bones as you move your ankle. Most ankle bursitis cases involve the bursa located between the heel bone and the achilles tendon. It is called the retrocalcaneal bursa and the bursitis that it causes is known as achilles tendon bursitis.

However, there are two additional bursae present in ankle joints that have suffered certain types of stress:

• The subcutaneous calcaneal bursa, which forms at the back of the heel. This is responsible for ankle bursitis in women who wear high heeled shoes extensively;
• The subcutaneous bursa of medial malleolus, located on the bony protrusion on the inner ankle.

Ankle Bursitis

Most cases of ankle bursitis have the following contributory causes:

• Overuse from repetitive physical activity, especially walking, jumping or running on hard surfaces;
• Extensive running on upward sloping surfaces with proper preparation in the form of warming up or stretching;
• Wearing poorly fitting shoes that exert unusual pressures on the feet;
• Previous ankle injuries;
• High amounts of inflammation in the ankle joint, possibly due to rheumatoid arthritis or gout;
• An infection in the ankle joint (septic bursitis) that then spreads to the bursae;
• A direct blow to the ankle;
• Haglund’s deformity, which causes heel bone enlargement

Symptoms Of Ankle Bursitis

The main symptom of ankle bursitis is a painful heel. In addition, you may also experience:

• Swelling near the top of your heel bone;
• Increased pain when you press on the back of your heel or flex your foot (point the toes upward);
• Increased pain when you stand on tiptoe;
• For severe cases of bursitis, you may be forced to limp to keep pressure off your ankle;
• If the bursa between the heel bone and achilles tendon is inflamed, that area may be red;
• If your bursitis is the result of an ankle infection (septic bursitis) you may also experience fever or chills.

Diagnosis

The principal way to diagnose ankle bursitis is through a physical examination of the ankle. This involves checking the area for signs of inflammation. Your doctor may also want to check that you feel increased pain when moving the ankle as described above.

In some cases, doctors may request additional tests to rule out other possible problems. For example, he or she may request an X ray to confirm that you don’t have a fractured ankle.

MRI scans can show the condition of the ankle bursa and the extent of any swelling.

If the doctor suspects an infection, fluid may be drawn from the ankle to determine what type of bacteria may be present.

Ankle Bursitis Treatment

As with most soft tissue injuries, the preferred initial treatment plan for ankle bursitis will be based on non invasive methods. You will likely be advised to follow this routine for a couple of weeks:

• Take a break from high impact activities that stress your ankle. If necessary, switch to low impact activities like swimming;
• To reduce swelling and pain, apply ice to your ankle for 20-30 minutes at a time and at intervals of 2-3 hours;
• If the pain is severe, take an over the counter pain relief medication like Tylenol;
• To reduce high levels of inflammation in the ankle, take a non steroidal anti inflammatory drug (Ibuprofen for example) instead of a pain killer;
• Make sure that your shoes are roomy and don’t place pressure on your feet. Use shoe inserts if necessary to prevent pressure on sensitive or painful areas of your feet;
• Physical therapy exercises may help to reduce ankle pain and speed recovery.

If these measures don’t produce significant improvement after a couple of weeks, seek medical advice. Your doctor may suggest other approaches. One popular treatment is a corticosteroid injection into the ankle bursa to reduce inflammation.

If your doctor confirms that you have septic bursitis (i.e. your ankle bursitis is due to an infection) treatment will include antibiotics.

Preventing Ankle Bursitis

Here are a few simple steps you can take to reduce your chances of suffering from this condition:

• Stretch and warm up before any exercise or sporting activity;
• Be careful to use footwear with plenty of room and proper cushioning/support;
• Cross train by mixing high and low impact activities. This will reduce the long term stress on your ankles and feet.
• If you strength train, increase your weight/resistance level gradually. Allow yourself to get used to each level before moving to the next.