One of the most common foot pains in athletes, especially runners, is Achilles bursitis, which may be defined as swelling of the Achilles bursa (subcutaneous calcaneal bursa). The Achilles bursa is located between the skin and the posterior aspect of the distal Achilles tendon. A burse is a fluid filled sac that decreases friction between two tissues
- A direct blow to the Achilles bursa can produce inflammation and irritation.
- A fall where one lands improperly on the ankle or Achilles bursa.
- Constant pressure on the Achilles bursa from use of the ankle.
- Repeated stress injury to the Achilles bursa and tendons from a high level of activity, which can also cause tendonitis in addition to bursitis.
- Complications from rheumatoid arthritis, osteoarthritis or gout.
- Infection of the Achilles bursa or ankle.
- Achilles bursa can become swollen as a response to other ankle conditions.
- Pain and tenderness over the location of the Achilles bursa along the back of the ankle near the heel
- Loss of motion of the ankle
- Pain with activities that stress the Achilles bursa like walking, jumping, running or activities that cause stress on the tendons that are lubricated by the Achilles bursa
Avoiding the activities that produce the pain or stress the Achilles bursa is the first line of treatment.
- Avoiding activities that produce pain or stress of the Achilles bursa and associated tendons (jumping, running, etc.)
- RICE: (Rest, Ice, Compression, Elevation) should be used to reduce the stress on Achilles bursa
- The use of ice to reduce inflammation and pain.
- NSAIDS (nonsteroidal anti-inflammatory drugs)
- Physical Therapy
- Drainage of the fluid in the Achilles bursa for severe cases. Fluid can be checked for possible infection.
- Antibiotic in the case of infections of the Achilles bursa
- Steroidal injections in non responsive cases
- Surgery to remove the Achilles bursa may be indicated in extreme cases if the problem becomes chronic.
Physical Therapy Interventions
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals. Physical therapy for an ankle bursitis must remain conservative at the onset in order to not aggravate the condition. Emphasis will be in rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and ankle joints.
Common Physical Therapy interventions in the treatment of Achilles bursitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the ankle. Use of mobilization techniques also help to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the ankle to support, stabilize, and decrease the stresses place on the Achilles bursa and tendons of the ankle joint.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, or jumping) of the involved lower extremity to reduce stress on Achilles bursa and tendons in daily activities.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the Achilles bursa.
- Home program including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
In general, patients respond well to conservative treatment of ankle bursitis. It is important that once the pain and inflammation is reduced and motion and strength are restored that the patient gradually returns back to full activities. Instruction in daily activities or sport performance is helpful to reduce the chance of a reoccurrence of the bursitis. In most cases full return to activity will take from 2-6 weeks depending on the severity of the condition. As a preventive measure individuals should:
- Make modifications in work or daily activities and avoid positions that stress the Achilles bursa or wearing protective equipment to avoid prolonged pressure or unexpected blows on the Achilles bursa.
- Maintain strength and flexibility to reduce stress on the Achilles bursa and tendons of the ankle.
- Avoid highly repetitive activities whenever possible.