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The ankle joint comprises 4 bones; the Talus, Calcaneus (Heel Bone), Tibia and Fibula. At the end of several bones in our bodies is bursa, which are sacs of fluid that cushion the bone from impact and prevent tendons from rubbing directly off the bone. There are 3 of these bursae on the ankle joint; the retrocalcaneal bursa, the subcutaneous calcaneus bursa and the subcutaneous bursa of the medial malleolus. If one or more bursa becomes irritated or compressed, they become inflamed, resulting in ankle bursitis.
The symptoms of Ankle Bursitis include pain and swelling at the back of the ankle that is exquisitely tender to the touch. Patients report being unable to put on their shoes as the pressure of the heel cup is too painful.
Patients may be unable to bear full weight due to the severity of the pain, particularly for retrocalcaneal bursitis, as it becomes compressed by the Achilles Tendon in dorsiflexion.
Symptoms are aggravated by walking uphill, walking up stairs or impact activity such as running or jumping.
The most common cause of Ankle Bursitis is a direct impact on the heel bone, which can result from a kick in a sport or an impact from a hockey stick. Retrocalcaneal Bursitis is often associated with Achilles Tendonitis or Insertional Achilles Tendonitis, although we are unsure if this is a direct cause of Ankle Bursitis.
Repetitive overuse of the ankle joint or a sudden increase in use can cause Ankle Bursitis from activities such as walking, hiking, running or jumping.
Other causes of Ankle Bursitis include Gout, Arthritis, infection and tightly fitted shoes.
A clinician, such as a Physical Therapist of a Podiatrist, can diagnose Ankle Bursitis based on a Physical examination. If the clinician is unsure of the diagnosis or would like to rule out other conditions, they may refer for a scan. An Ultrasound scan is a cost-effective method of identifying Ankle Bursitis and can rule out other conditions, such as Insertional Achilles Tendonitis.
For a more detailed scan, an MRI may be requested, while an x-ray cannot diagnose Ankle Bursitis.
Ankle Bursitis is primarily an inflammatory condition, so the first treatment steps are to reduce inflammation through icing, anti-inflammatories, rest and avoiding compression of the bursa.
Physical Therapy is an excellent solution once the acute pain of Ankle Bursitis has reduced. A physical examination can identify muscular imbalances that can cause an overload of the bursa, while a gait analysis can identify biomechanical faults that can also contribute to an overload.
A thorough rehabilitation protocol consisting of strengthening exercises, stretches and balance exercises alongside insoles and recommended footwear is an effective form of treatment.
In some cases, steroid injection under ultrasound guidance is required to reduce inflammation levels of the bursa, but there is a risk of infection.
Surgery is required to remove the bursa in rare cases, while if it is an infection causing your ankle bursitis, then antibiotics may be prescribed.
This is not medical advice and we recommend a consultation with a medical professional such as James McCormack before trying any of these exercises. James offers Online Physiotherapy Appointments for £45.