Ankle Bursitis

The bursae are small fluid filled sacs that are located at various points in the ankle joint. They reduce friction between the bones of the ankle and adjacent tendons.  In doing so, they lubricate the joint so that the bones can move freely during actions like standing, walking and running.

Ankle bursitis causes swelling and pain around the ankle, particularly when movement of the joint is attempted.

Treatment of ankle bursitis usually requires resting the ankle joint by refraining from activities that could stress it. This allows the bursae to recover naturally. To reduce the pain of the condition, doctors may also suggest using pain relief medication and icing the ankle.

Ankle Anatomy

The ankle is the point of intersection of four bones. These are:

• The tibia (the larger of the lower leg bones);
• The fibula; the second lower leg bone, which is on the outer side of the tibia;
• The talus, which is the ankle bone itself; and
• The calcaneus, or heel bone.

The talus is located at the junction of the other three bones. Imagine wearing shoes with laces – the talus would be located close to the top of the laces.

The top of the talus fits into a socket formed by the two lower leg bones and its lower part fits into the heel bone.

The main bursa of the ankle joint is the retrocalcaneal bursa, which sits between the heel bone and Achilles tendon. Bursitis due to inflammation of this bursa is known as achilles tendon bursitis.

In addition, ankles that are subject to significant stress can develop two additional bursae:

• The subcutaneous calcaneal bursa, which is located at the back of the heel;
• Subcutaneous bursa of medial malleolus, which is just below the inner surface of the ankle and at the end of the tibia.

Ankle Bursitis Risk Factors

Some of the things that can increase the risk of developing bursitis in the ankle joint include:

• Repeated physical activity that causes strain on the ankle over time (an overuse injury);
• Wearing poorly fitting shoes;
• Running uphill before stretching properly or without adequate training to do so;
• Having a previous ankle injury;
• Suffering from ankle arthritis. Rheumatoid arthritis of the ankle can lead to large amounts of inflammation near the ankle joint. Gout is another inflammatory type of arthritis that can also lead to ankle bursitis;
• Developing an ankle infection (which can lead to septic bursitis);
• Abnormal enlargement of the heel bone (Haglund’s deformity);
• Receiving a direct blow to the ankle.

Symptoms

Usually, ankle bursitis symptoms tend to develop gradually. The first sign may be pain around the heel bone.

Other subsequent symptoms may include:

• Swelling at the top of the heel bone;
• Increased pain when someone or something touches the back of the heel ;
• Increased pain during foot flexion (i..e. bending the  foot so that the toes move up towards the shins);
• The pain may also become more severe when standing on tiptoe;
• Being forced to limp in order to avoid putting the full body weight on the ankle;
• Redness over the achilles tendon (if the patient has achilles tendon bursitis);
• If the bursitis is due to an infection, the patient may also start experiencing fever or chills.

Diagnosis

Diagnosis of ankle bursitis is usually done by way of physical examination. In other words, the diagnosis is usually made clinically. Imaging tests are not often needed. Doctors will check for visible indications of inflammation. They may also palpate (examine by touch) the ankle to determine precisely which areas hurt when ankle movement is attempted.

In some cases, a doctor may request an X ray to rule out an ankle fracture. An MRI may be requested in order to examine the bursa and check it for signs of swelling.

Fluid samples will be taken if the doctor suspects an infection. The purpose of the sample will be to determine the type of infection. This will then help the doctor to decide which antibiotics to use to treat the infection.

Treatment Of Ankle Bursitis

As with most soft tissue injuries, doctors will first try conservative non invasive treatment options. Often, conservative measures are all that are needed for the condition to heal. Conservative measures which can be tried include the following:.

• Rest the ankle by refraining from strenuous activity like walking or running
• Use cold therapy  to reduce swelling, pain and inflammation. Apply ice or a cold compress at intervals of 2-3 hours and for 15-20 minutes at a time;
• Doctors may suggest anti inflammatories like Ibuprofen or Naproxen to further reduce inflammation;
• Switch to using shoes with plenty of cushioning and room;
• Try to reduce friction between the heel bone and shoes by using shoe inserts.
• Consult with a physiotherapist who can devise a physical therapy exercise program to speed recovery. These exercises can also help to reduce the risk of recurrence of the bursitis.

If these measures do not work, additional medical advice should be sought.The physician may suggest a corticosteroid injection into the bursa as a way to combat inflammation.

It is advisable for a patient to see a doctor if their symptoms are not improving or worsening after 1-2 weeks of conservative treatment, if they have a high temperature, are feeling hot and shivery or if they are unable to move the affected joint. These signs and symptoms can mean that you have an infection that will need treatment with antibiotics.

If the ankle bursitis is thought to be caused by an infection of the ankle joint, doctors will probably opt for antibiotic use as a first option instead of the conservative measures listed above.

Prevention

To reduce the risk of developing ankle bursitis, we would suggest the following:

• Try to stretch and warm up properly before any type of exercise or strenuous activity;
• Avoid poorly fitting footwear or shoes with inadequate support; and
• Consider cross training by interspersing high and low impact activities. Low impact activities would include swimming, cycling and other types of exercise that are less stressful to the ankles;
• Maintain a healthy weight; being overweight puts more pressure on the joints;
• Use of padding when engaging in activities that put pressure on a joint (like kneeling for example).