If we all think back, most of us can remember hearing our parents or grandparents talk about their bursitis flaring up because of the weather. Bursitis is a common painful inflammatory condition that can affect any part of the body including the foot and ankle.

There are over 150 bursa (pronounced bur-SEE) in the human body.  Usually bursa are present from birth, but they may form in response to pressure. Bursa is a small fluid-filled sac located near the bones around joints and between muscles.  Each Bursa contains a small amount of clear synovial fluid, that cushions and lubricates the movement of the tendons and muscles over bone.

Bursitis (bur-SY-tis) is inflammation of a bursa.  The most common locations for bursitis are in the shoulder, elbow and hip. But you can also have bursitis in your lower extremity in the knee (housemaid's knee), heel (Achilles) and the base of the big toe (part of the bunion).  The inflammation limits the joint motion (referred to as "frozen joint") and causes pain whenever the joint moves. Bursitis may be acute or chronic. The chronic form tends to come and go over weeks or months.

Causes of bursitis

Bursitis often occurs near joints that perform frequent repetitive motion. Bursitis is most often caused by frequent repetitive movement and is known by several common names, including tailor's bottom, clergyman's knee, housemaid's knee, and miner's elbow, depending on the location  of the injury. Bursitis can start in four different ways:

1. Trauma or injury:  An injury that causes deep bruising, could cause inflammation of a bursa. This will often clear up without treatment.

2. Overuse: Inflammation can result from repetitive strain placed on a joint, or continuous pressure on the bursa itself (example by kneeling).

3. Inflammatory arthritic disease: Conditions like rheumatoid arthritis and gout can lead to the release of inflammatory agents into the bursae.  Also, calcium crystals can form in the sacs, causing friction and tearing.

4. Infection: Many common bacteria can infect the bursae

Symptoms

The essential symptom of bursitis is pain that is near the joint, often accompanied by redness, tenderness, and swelling.  The pain is worse when you make new movements or strain the joint and muscles. Severe or long-lasting bursitis can lead to reduced movement or use of the joint and result in muscle wasting. Permanent changes in the shape of the bursa, such as thickening or swelling can occur and the tissues around the joint can become chronically inflamed.

Diagnosing bursitis

Many other diseases can cause joint pain or bursitis-like symptoms in the foot and ankle, so it's important that you see a podiatrist for a proper diagnosis and treatment. Before making a diagnosis of bursitis, a number of possibilities need to be ruled out. Your doctor may ask you to take blood tests for rheumatoid arthritis and an x-ray to rule out osteoarthritis. If the joint is hot, red, and swollen, your podiatrist will want to check for bacteria and rule out an infection. Your doctor will diagnose bursitis with a physical exam and tests such as x-rays and MRIs.

Treating bursitis

Treatment typically involves resting the affected joint and protecting it from further trauma. In most cases, bursitis pain goes away within a few weeks with proper treatment, but recurrent flare-ups of bursitis are common.

A mild case of bursitis is usually treated with rest or a splint, ice packs, or aspirin or other anti-inflammatory medications. Physiotherapy treatments like ultrasound may also be helpful. If these treatments don't work, you may be given an injection of corticosteroids mixed with a local anaesthesia into the bursa. Sometimes it may be necessary to draw some fluid out of the joint with a needle to see if there are signs of infection in the joint.

When recovering from bursitis, it's important to exercise the joint to make sure there is full range of motion so that you do not end up with a stiff joint.  Your podiatrist or therapist can give you a detailed exercise depending on which joint is used and the amount of muscle loss. If the joint still does not improve after six to 12 months, you may need surgery to repair damage and relieve pressure on the bursa.

o If you have or think you may have bursitis or if you want more information, visit www.chealth.ca, www.aaos.com and  www.NIH or contact us at foothealth242@gmail.com.

To see a podiatrist call or visit Bahamas Foot Centre on Rosetta Street - 325-2996 or Bahamas Surgical Associates on Albury Lane - 394-5824.

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