Bursitis

Pain and symptoms felt in the front of the knee from bursitis

What is bursitis?

Bursae (or singularly, bursa) are fluid filled, semi compressible, sac-like structures present all throughout your body. Their function is to facilitate movement and cushioning between the tendons and bones in our musculoskeletal system.

There's over 140 bursae in the body and without them, our tendons, ligaments and muscles would not be able move smoothly with the bones when using the joint. 

When bursae become subjected to higher levels of stress and/or irritation, they become inflamed, enlarged and painful — this condition is called bursitis.

Causes

The most common cause of bursitis is overuse and repetitive movements. A few examples of repeated movements that may cause bursae's to become problematic are; gardening, painting, cleaning, running, cycling, golf and tennis.

Diagram comparing a bursitis knee joint against a healthy knee joint


Other causes of bursitis include:

  • Long periods of standing on your feet or kneeling
  • Overloading and overuse with excessive training loads
  • Poor range of motion and mobility in joints creates increased loading on the bursae
  • Overpronation of the foot (when your foot rolls inward excessively)
  • Flat feet and high arches
  • Tight and poor fitting footwear can cause foot and ankle bursitis
  • Direct trauma such as a blow to your knee
  • Irregular gait patterns

Who is at risk?

Considering the potential causes of bursitis, there are certain factors that can increase your risk of developing the condition:

  • People over the age of 40 as the shock absorbing fat pads in your weight bearing joints (e.g. feet & knees) begin to compress/degenerate over time.
  • Careers or hobbies that require repetitive motion over long periods of time that increases the pressure placed on a bursa.  Some examples are; roofers, gardeners, painters or carpet layers
  • Suffering from certain diseases and conditions like rheumatoid arthritis, osteoarthritis, gout, bunions or diabetes.
  • If you have a Hallux abducto valgus (bunion of the big toe joint) or tailor's bunion (bunion of the little toe joint)

    Symptoms

    Bursitis commonly occurs around major joints like your hip, knee, ankle and heel. If you start to experience localised pain at these joints with or without swelling, then you may have bursitis. 

    Other bursitis symptoms associated with the condition may include:

    • Tenderness
    • Stiffness, limited range of motion and reduced mobility in the joint
    • Redness and mild warmth in the area (it is important to note, this can sometimes be a sign of an infection not bursitis)
    • Pain with activity and daily living
    • Numbness, burning and tingling if the nerves are impacted by the swollen bursa, which is common
    • Pain during movement, especially when walking barefoot

      Our podiatrists can see and treat all of the following areas where bursitis may occur:

      • Trochanteric bursitis (Side of your hip)
      • Prepatellar bursitis (knee cap) 
      • Pes anserine bursitis (back and/or inside of knee)
      • Retrocalcaneal bursitis (back of the heel and ankle)
      • Forefoot bursitis (which can occur in any of your toe joints or joint spaces)

      Diagnosis

      The signs and symptoms of bursitis closely resemble those of tendonitis (inflammation of a tendon), so it's important that our podiatrists are able to correctly diagnose your condition.

      To diagnose bursitis, we would firstly complete a physical assessment of the area and further specialised bursitis assessments. Once pain is replicated, ultrasound imaging may be used to confirm the diagnosis of bursitis and to see if the nerve has been impinged or damaged. 

      Treatment

      When treating bursitis, we will often suggest a personalised combination of the following treatments to allow you to achieve the fastest and most effective recovery.

      • The RICE protocol - rest, ice, compression & elevation
      • Strengthening and stretching exercises in conjunction with foot mobilisation techniques (FMT).
      • Adapt and modify your training program depending on the location of the bursitis.
      • Supportive footwear with cushioning soles.
      • Custom prescribed foot orthotics may be recommended to offload the sore, overused structures and soft tissues.
      • Foot and ankle strapping depending on the location of the bursitis.
      • Shockwave therapy to accelerate the healing process
      • Dry needling of surrounding soft tissue structures to release tension in the muscles
      • Anti-inflammatory medication
      • Corticosteroid injection

          Your condition is likely to improve in a few days or weeks if you rest and treat the affected area, however, if you don't stretch and strengthen the muscles around the joint and modify your daily activities or exercise, it may return. 

          What can happen if I leave bursitis untreated?

          • You may experience a chronic, prolonged healing process 
          • Morton's neuroma can simultaneously occur due to impingement and irritation of the parallel nerves 
          • Inflammation of surrounding tissue structures 
          • Altered walking and running patterns that may result in a secondary injury

          Prevention

          While not all types of bursitis can be prevented, the following activities may help to reduce your risk. 

          • Use kneeling pads or cushions when resting your joints on a hard surface e.g. sitting or kneeling.
          • Regularly stretch and strengthen the muscles of your lower limbs with specific exercises.
          • Take frequent breaks.
          • Alternate between activities when performing repetitive tasks.
          • Warm up and stretch before engaging in sports or strenuous exercise.
          • Start or increase training slowly, by gradually increasing time and intensity. 
          • Don't sit still for long periods of time.
          • Maintain a healthy bodyweight to relieve pressure on your joints.
          • Ensure you're not wearing unsupportive, ill-fitting or worn out footwear. 

          FAQs

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