Bursitis on the heel
What is Heel Bursitis?
A bursa is a fluid-filled structure. This is located in places where the bones and tendons are directly above one another. The bursa in between is designed to reduce the friction between the tendon and the bone. In addition, the wider contact surface of the tendon on the bone distributes the load across the entire joint. In particular, if the heel is overloaded, the bursa can thicken and become inflamed. In doing so, it presses on the surrounding structures and causes pain. This pain is most noticeable when walking and running.
Read more general information on this topic at: Bursitis
The medical term for bursitis of the heel is calcaneal bursitis.
The inflammation causes the bursa to thicken, causing pain in the surrounding tissue. The bursa can easily become inflamed, especially when there is excessive stress in running sports (handball, basketball, soccer, jogging, triathlon, athletics). Other causes can be existing inflammations on the foot that spread to the bursa. Bacterial inflammation of the bursa on the heel is also possible. This is called septic bursitis. If the inflammation develops as a result of trauma, bleeding into the bursa is often the cause. In this case it is called hemorrhagic bursitis.
When jogging, the entire body is caught by the foot with every step. Especially those runners who start their stride with the heel (as opposed to forefoot runners who come down with the ball of the foot first) are more likely to suffer from bursitis of the heel. The inflammation can be triggered by running too hard or increasing the workload quickly. New jogging shoes also change the load and can cause bursitis on the heel, as does jogging on hard and / or uneven surfaces such as cobblestones.
Read more interesting information on this topic at: jogging
Haglund's heel is a disease in which the attachment of the Achilles tendon to the bone is changed. The tendon attachment is ossified at the top of the heel. This disease can arise both during a growth phase and later in adulthood. A shoe that is too hard or too tight and irritates the tendon over a long period of time is discussed as a possible cause. The ossification of the tendon attachment leads to overloading of the bursa, which lies between the heel and the bone. In the long run, this leads to bursitis. Treatment of Haglund's heel consists of relief and possibly pain relieving medication.
Read more on this topic at: Haglund's heel
In the articulated foot, the inside of the foot is lowered, while the outside is raised more. This misalignment of the foot changes the foot axis minimally, which leads to a changed direction of pull of the Achilles tendon. The bursa, which is located between the Achilles tendon and the bone, is designed to prevent these two structures from rubbing against each other. However, it is anatomically oriented towards a certain direction of pull of the Achilles tendon. If this direction changes, the bursa is permanently irritated, which can lead to a bursitis. The bursa below the heel is also stressed differently than planned anatomically. Incorrect stress can lead to inflammation there too.
You can find more information on this topic at: Buckle foot
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These symptoms will help you recognize bursitis on your heel
Primarily, heel bursitis is characterized by pain in the heel. These usually occur during exertion, especially during exercise. But the inflamed bursa can also be felt when walking. Anyone who has suffered a trauma to the heel and subsequently suffers from bursitis, often already has pain at rest and without stress. The swelling of the bursa makes a swelling visible on the heel, resulting in a feeling of pressure on the skin above the bursa. In the case of particularly severe inflammation, reddening and overheating can also be noticed on the skin.
The pain of a bursitis on the heel occurs mainly during exercise, but it can also be felt at rest. The inflammation causes the bursa to thicken, putting pressure on the surrounding tissue and causing pain. The inflammation releases chemical substances that are supposed to call up immune cells. These substances, the so-called inflammation mediators, can irritate the pain-conducting nerve fibers and thus also trigger pain. The cooling of the heel usually counteracts the pain therapeutically. Ointments and pain relievers can also be used temporarily.
The swelling of the bursa and the surrounding tissue in a bursitis is mostly due to the inflammatory reaction. The inflammation releases chemical substances that activate the body's defense reaction. As a result, immune cells are called to the scene of the action, and at the same time more fluid is released into the tissue. This build-up of fluid will show up as swelling. There is not much cushioning tissue on the heel in particular, which is why a small additional amount of fluid is noticeable.
The diagnosis of bursitis is based primarily on a physical examination of the heel and the questioning of the affected person by the doctor (anamnesis). In the anamnesis, the doctor can inquire about the type of pain and other complaints, and the causes of the symptoms are also highlighted. During the examination, the heel is examined primarily for signs of inflammation (redness, swelling, overheating, pain). In order to reliably diagnose the bursitis, then an ultrasound is usually sufficient. In it, fluid-filled tissue such as the bursa can be shown well. Therefore, an inflammation of the bursa is quickly apparent in the examination.
The most important part of treating bursitis on the heel is to protect the affected foot. Only in this way can the bursa come to rest again. The foot can be put up to relieve symptoms such as pain and swelling. Cooling the affected heel is usually also helpful. When walking, special insoles can be used to specifically relieve the heel.
Pain relievers and anti-inflammatory ointments can also be used in the treatment. Further treatment options are physiotherapy, shock wave or laser therapy. Also, draining fluid from the bursa can be considered. However, these therapies are usually only used when symptoms persist.
Please also read our topic: Surgery for bursitis
Taping helps with bursitis on the heel, especially if the bursa at the attachment point of the Achilles tendon is affected. The calf muscles can be supported with the help of kinesio tape. This relieves the Achilles tendon and thus also the bursa underneath. If you have complaints about the bursa that is below the heel, taping is often difficult and not as effective.
Also read the article:Achilles tendon bursitis.
With lasers, highly concentrated light waves are shot at the affected heel by means of a laser. On the one hand, this stimulates the blood circulation in the area; This leads to an increased number of cells that can fight the inflammation of the bursa. A great advantage is the very local effect of the laser therapy. However, changes also occur throughout the body. This particularly affects the endorphin level, which can reduce the sensation of pain.
Shock wave therapy
Shock wave therapy consists of pressure waves that can move easily through water and thus through structures filled with fluids. If these waves hit hard structures, they discharge their energy there. This effect is used in the treatment of bursitis. The waves can be sent through the bursa very well. If they encounter calcium deposits there or on the tendon above, these are reduced or destroyed by the shock waves. Since the calcium deposits usually cause more friction on the tendon and the bursa, the destruction of these deposits removes a major irritant factor. This improves the bursitis and reduces pain.
Further information on this topic can be found at: Shock wave therapy
These home remedies can help
Home remedies can target different mechanisms for bursitis.
- Cooling home remedies are primarily used to reduce pain, but at the same time they also briefly reduce the inflammation in the bursa. A simple ice pack or cold pack can be used for cooling. Quark or cabbage wraps can also have a cooling effect.
- In the case of acute bursitis, home remedies that have an analgesic effect also help. This includes ginger, for example, which is freshly grated and briefly boiled. The cooled ginger is then placed on a kitchen towel and placed on the painful heel. Apple cider vinegar and willow bark are also pain relievers.
- Those who, on the other hand, have been suffering from bursitis for a long time and thus tend to chronify the pain, usually also benefit from the application of heat. Massages and heat treatments stimulate blood circulation and thus help the body to fight inflammation more effectively. A massage also reduces muscle tension and thus relieves the bursa. Castor oil can be added to a warm cloth. This allows it to develop its anti-inflammatory component in addition to the relaxing warming effect.
Fascia are layers of connective tissue that surround the muscles. These can stick together and thus cause pain, they also lead to an overload of the muscles and thus also promote bursitis. Fascia therapy can, for example, be carried out with a fascia roller. This loosens stuck fascia and makes the muscles more supple. This reduces the strain on the bursa on the heel.
Duration of bursitis on the heel
Bursitis on the heel is often an annoying and long-lasting condition. It can drag on for months to years. In order to prevent the symptoms from becoming chronic, however, consistent protection of the affected foot is necessary. With further overload, it can lead to chronic bursitis, which lasts permanently or at least for several years. Anyone who has overcome the bursitis after a few months can start with a careful training structure. If this succeeds, an immediate relapse is rather unlikely.
Further interesting information on this topic can be found at: Duration of bursitis
What can you see in a treadmill analysis and how can I use it to avoid pain in the heel?
The treadmill analysis focuses on the position of the feet with every step. A distinction can be made between forefoot and heel runners. Forefoot runners put more stress on the ball of the foot, heel runners put more stress on the heel. In addition, it can be analyzed whether the foot bends inwards or outwards when stepping on. Since these misalignments can lead to incorrect loads on the foot, they promote the development of bursitis. Based on the treadmill analysis, a shoe can be selected that prevents this kinking. This can reduce the risk of bursitis.
Read more on the subject at: Treadmill analysis
Running shoe adjustment
The running shoe fitting is usually done after a treadmill analysis. As a result, a running shoe can be selected which, for example, reduces the lateral kinking of the foot. A stabilizing sole is usually sufficient for this. If there is already a bursitis, special soles can be used that particularly cushion the heel and thus reduce the pressure on the bursa. In the case of severe discomfort, a sole that has a hole in the heel can also help. In this way, the body weight is distributed to other parts of the foot, while the heel itself is relieved.
Stabilization exercises primarily focus on the ankle and thus lead to safer walking. This improves the movement of the muscles, which permanently reduces the strain on muscles and tendons. This can prevent bursitis. Stabilization exercises are also important after a long break from running due to bursitis, because the foot can find its way back to its normal running load more quickly.