Foot Bursitis: What To Do with that Pesky Ball of Foot Pain

If we think of the body as a building, then the feet are the foundations that keep everything stable. Except, unlike buildings, our bodies are meant to constantly move around, jump, and adjust their centers of gravity. As a result, feet are made from a myriad of tiny parts – from bones to ligaments to muscles – meant to provide it with equal parts resilience and flexibility.

The more parts a machine has, the frailer it is to maintain. This is why there are so many medical conditions that can cause foot pain: according to a systematic review, up to 25% of adults have some sort of painful foot condition that can impair movement.

Let’s examine bursitis, a common cause of inflammatory pain that is particularly noxious to athletes. If you’ve ever felt the balls of your feet swelling or “burning from the inside” after a long walk, then you may have bursitis.

But what can you do about it?

Man massaging foot for ball of foot pain.

What is bursitis in the foot?

Just like every other condition that ends in “itis,” bursitis is all about inflammation – in this case, inflammation of a bursa. The bursa (plural: bursae) are tiny, fluid-filled sacs that surround the joints and surrounding bones. They act as cushioning and protection.

Whenever two bones meet at a movement point (such as your elbow, knee, or each one of your toes), the end of each bone is covered in a smooth layer of cartilage. However, the cartilage could still get damaged if you constantly rub them against one another! Instead, the small fluid “bubbles” (bursae) let cartilage glide without directly touching each other.

Naturally, the fluid can’t just swim around the area freely. The bursae are made from a thin layer of soft tissue keeping everything together. It’s meant to be flexible, but if you are constantly pounding against the pavement, the tissue can get inflamed.

Types and symptoms of bursitis

Bursitis can affect any joint in the body, but it is more common on the “big” joints that we move more frequently: the shoulders, the hips (trochanteric bursitis), the knees (patellar bursitis), and the elbows.

All types of bursitis share the same main symptom: pain. Occasionally, you can also see skin redness and swelling or the skin may feel warm to the touch. The pain tends to get worse every time you move the affected joint. In severe cases, pain and stiffness may prevent you from moving the joint altogether.

When it comes to bursitis in the foot and ankle, there are three major “frail points” where you can develop bursitis:

  • The back of your Achilles’ tendons: Sometimes called “plantar calcaneal bursitis,” this affects the joint that attaches your calves and ankles to the heel bone – right below the skin. You may feel sharpe pain every time your heels hit the pavement, or after standing for too long.
  • Beneath the malleolus (the bony bump on the inside of the ankle): This is known as retromalleolar bursitis or “Albert disease.” It affects the inner joint that connects the front of the Achilles tendon with the rest of your foot. This type of bursitis may make it painful to extend or rotate your foot, compromising your balance.
  • The start of your toes (intermetatarsal bursitis): This type of bursitis affects the joints that connect the toes with the main part of your foot. It can be particularly painful if you are trying to tiptoe.

Causes of bursitis in the toe

Most of the time, bursitis is an overuse injury – that is, it develops following the continuous damage of everyday use, rather than after a single blunt accident.

As a result, bursitis in the foot and ankle is remarkably common among runners and basketball players: both sports require you to pound your feet repeatedly against the pavement.

In addition, other conditions and choices can increase your risk of bursitis:

  • Frequent use of high heels and pointy shoes
  • Using excessively tight shoes or shoes with no back support
  • Other foot deformities or problems, such as bunions, hammer toes, or Haglund’s deformity (a hard, round bump on the heel)
  • Increasing your physical activity levels abruptly
  • Being overweight
  • Other joint conditions such as gout or rheumatoid arthritis

In very rare cases, bursitis may stem from a widespread foot infection, especially if the bacteria infection is around the bursae. In these cases, the soft tissue sac can get full of pus, which can be very painful and dangerous.

Diagram of normal heel versus heel bursitis

What can I do to prevent bursitis?

Whether you’ve never experienced it, or you only feel the occasional joint discomfort, preventing bursitis is remarkably less painful than treating it.

The best way to prevent bursitis? Exercise safely. This doesn’t mean skipping a workout, or denying yourself the continuous challenge or thrill of a new personal best. It just means incorporating a few precautions into your fitness plan.

Mix up your workouts

Bursitis often stems from repetitive motion. If you perform the same movement hundreds of times every day, you will eventually inflame the joint. Instead, try switching up your workouts, incorporating a couple of sessions a week that require different movements.

This can be as simple as splitting your leg days from your arm and chest days. You can also try to add a softer, flexibility-based session (such as yoga) in between running sessions.

This also applies if your work requires you to stand up for long periods of time.

Invest in your gear

Properly fitted shoes that minimize impact, provide arch support, and adapt to your gait are essential to prevent straining your joints (and your bursae).

This is particularly important if you are overpronating or underpronating, or if you have a history of other issues such as plantar fasciitis or flat feet. Any of these issues can cause you to unconsciously adjust your gait to protect your trouble areas. In turn, this will cause a stronger strain on the opposite side.

If you want to power up your balance, you can also go beyond your shoes. Orthopedic inserts, padded socks, and support bandages can all help you maintain adequate form while you exercise.

Build up slowly

Sacrificing safety for the sake of time can be a costly mistake. This applies for both your exercise program and each individual session!

When you’re starting with a new discipline or technique, make sure you give yourself a slow start – at least until you master the form. And no matter how much experience you accumulate, take the extra five minutes to warm up properly.

Finding definitive relief: Foot bursitis treatments

Although it can abruptly get in the way of your activities, bursitis can be treated. In most cases, conservative treatments and over-the-counter medications will be all you need.

So, what to do after noticing foot bursitis symptoms? This will depend on the severity and frequency of the pain. Our recommendation: start with the simplest, least invasive treatment option, and work your way up only if you need it.

Try these home remedies

An effective, tried-and-true solution for sports injuries is RICE:

Blue ice pack on injured ankle
  • Rest – don’t move that foot today
  • Ice – apply a simple ice pack to the affected area
  • Compression – wrap your foot with an elastic bandage, but don’t go too tight (it will restrict the blood flow and worsen the swelling)
  • Elevation – keep the injured foot elevated for two to three hours a day

The RICE technique can help you lower inflammation and will help the pain subside more quickly.

In the meantime, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen will help you keep intense pain at bay.

When to see a doctor for bursitis?

If the pain is too intense, gets in the way of your daily activities, or refuses to go away, then it may be time to see a podiatrist or foot specialist. Other warning signs include:

  • If the foot feels burning hot
  • If you can’t move the foot at all
  • If you feel needles or sharp, lancing pain around the joint
  • If a lump or bulge appears around the painful joint

We have a few advanced tools in our arsenal, which can help you regain your mobility.

First, we will need an accurate diagnosis. Usually, this just requires a set of X-rays, but we need to see exactly which joint is inflamed and how much. This will also help us rule out similar conditions, such as hairline metatarsal fractures, fasciitis, or tendonitis.

If it looks like you have an infection, we may also need a blood test, or to take a fluid sample from inside the bursa. Again, this is very rare, as most cases of bursitis come from overuse.

If you need quick and intense pain relief, we can also use stronger steroids or cortisone injections directly into the affected joint. 

Injections act faster than oral anti-inflammatory medications, but they also increase the risk of infection, so they’re only a stop-gap measure. To make sure bursitis doesn’t return, shots are usually followed by a combination of physical therapy, a splint, or custom-made orthotics.

Sometimes, repeated bouts of intense inflammation can damage or rupture the bursa. If you get several intense episodes within a few months, you can begin to consider surgery.

Why Come to UFAI to treat Bursitis in Foot and Ankle

Whether you are struggling with recurrent bursitis, toe joint swelling, or are trying to regain your range of motion following an accident, our expert podiatry team is here to help. Our physicians are experts in every aspect of foot and ankle medicine.

From orthopedic surgery to performance-oriented sports medicine, our team offers one of the highest success rates in the nation.

Why? Because we combine deep expertise with a devoted support team comprised of specialized nurses, physical therapists, and technicians.

For a consultation please call (877) 736-6001 or make an appointment online now.

Our podiatrists take patients’ safety seriously. Our podiatry facility’s Covid-19 patient safety procedures exceed all the CDC’s coronavirus pandemic recommendations. Masks are always required in our institutes.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Westlake Village, Granada Hills, Valencia, and Santa Barbara.

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