Bursitis Treatment - Foot, Heel and Ankle

What Is Bursitis?

A bursa is a small fluid-filled sac that sits between bones, tendons and skin to reduce friction. Your body has bursae throughout – shoulders, hips, knees, and several in the foot and ankle. When one becomes inflamed, usually from repeated pressure, friction or direct injury, the result is bursitis.

In the lower limb, the most common sites are the back of the heel, around the Achilles tendon, between the bones of the forefoot, around the big toe joint, and over the kneecap.

A bursa works like a small water-filled cushion. When it’s irritated, it swells, and what was a cushion turns into a painful pressure point. Bursitis pain often mimics other conditions, which is why an accurate diagnosis matters. Many patients arrive having been told they have plantar fasciitis or Achilles tendonitis when bursitis is the actual driver.

Types of Bursitis We Treat

Lower-limb bursitis is not one condition. It’s a family of conditions that present and respond to treatment differently. Here are the most common types we see.

Retrocalcaneal Bursitis (back of the heel, deep)

Inflammation of the bursa between the Achilles tendon and the heel bone. This often coexists with insertional Achilles tendinopathy and Haglund’s deformity, a bony prominence at the back of the heel sometimes called a “pump bump.” Most common in runners and people who wear stiff-backed shoes.

Subcutaneous Calcaneal Bursitis (back of the heel, superficial)

Inflammation of the bursa just under the skin at the back of the heel. Usually caused by friction from shoe heel counters. Often visible as a red, swollen area at the back of the heel.

Intermetatarsal Bursitis (ball of the foot)

Inflammation of the bursae between the long bones of the forefoot. Causes pain in the ball of the foot, often confused with metatarsalgia or Morton’s neuroma.

Bunion Bursitis (big toe joint)

Inflammation of the bursa over a bunion deformity. Causes pain, redness and swelling on the inside of the big toe joint, often worse in narrow shoes.

Prepatellar Bursitis (kneecap)

Sometimes called “housemaid’s knee.” Inflammation of the bursa in front of the kneecap, often from prolonged kneeling. Where altered gait or footwear is contributing, this is a podiatrist-relevant condition.

Symptoms – and Why Bursitis Is Often Misdiagnosed

Bursitis symptoms vary by site, but a few patterns are consistent. The pain is usually localised over the affected bursa: sharp with direct pressure, dull with general use. There’s often visible swelling, sometimes as a soft lump for superficial bursae or only detectable on imaging for deeper ones. Redness and warmth can be present in superficial bursitis. The pain typically worsens with the activity that triggered it, whether that’s running, walking, kneeling or particular footwear, and the surrounding joint feels stiff.

The reason bursitis is so often misdiagnosed is that adjacent conditions cause similar pain:

• Retrocalcaneal bursitis is frequently labelled as Achilles tendonitis. The two often coexist, but the treatment focus differs.
• Intermetatarsal bursitis is often confused with Morton’s neuroma. Both cause forefoot pain, but the treatment is different.
• Calcaneal bursitis can be mistaken for plantar fasciitis if the pain location isn’t carefully examined.

The single most useful clinical distinction: bursitis pain is typically reproduced by direct, focal pressure on the bursa, whereas tendinopathy pain is reproduced by loading the tendon. A proper assessment can usually distinguish them.

What Causes Bursitis?

Bursitis rarely has one cause. Most cases are driven by a combination of factors:

• Repetitive stress. Running, jumping and prolonged walking are the most common drivers of retrocalcaneal and intermetatarsal bursitis.
• Footwear. Stiff heel counters drive retrocalcaneal bursitis. Narrow toe boxes drive bunion and intermetatarsal bursitis. Poor cushioning makes everything worse.
• Biomechanics. Overpronation, calf tightness and abnormal gait patterns shift load onto bursae that aren’t designed to carry it.
• Direct trauma. Falls, kicks and prolonged kneeling can trigger bursitis acutely.
• Underlying inflammatory conditions. Rheumatoid arthritis, gout and other inflammatory arthropathies can cause or worsen bursitis. This is why a proper history matters.
• Anatomy. Haglund’s deformity predisposes to retrocalcaneal bursitis, and the two are commonly seen together.

Identifying the cause is necessary for a treatment that lasts, not just a symptom fix.

How We Assess and Treat Bursitis at TLLC

Assessment – what to expect

Your assessment begins with a clinical examination: direct palpation of the bursae, range-of-motion testing, gait analysis and biomechanical evaluation. The differential diagnosis is the key step here, distinguishing bursitis from tendinopathy, neuroma, plantar fasciitis and other adjacent conditions.

Where imaging is clinically indicated, we have on-site diagnostic ultrasound. Ultrasound is the gold-standard imaging for bursitis, confirming the diagnosis and showing fluid collection within the bursa. For bony causes like Haglund’s deformity, X-ray referral may be arranged.

Diagnosis is established before treatment is recommended. We don’t guess.

Conservative treatment options

For most lower-limb bursitis, conservative treatment is the right starting point.

• Custom orthotics and offloading devices. First-line for retrocalcaneal, intermetatarsal and bunion bursitis. Orthotics correct the biomechanical drivers and offload the affected bursa. We manufacture them on-site in 48 hours, with same-day adjustments possible because the lab is here. /custom-orthotics/
• Footwear guidance. Specific to the bursa involved: heel counter modifications for retrocalcaneal bursitis, toe-box width for bunion bursitis, metatarsal padding for intermetatarsal bursitis.
• Foot mobilisation and stretching. Restoring normal joint movement and addressing calf tightness reduces the loading patterns that drive bursitis. /foot-mobilisation/
• Dry needling. For surrounding muscle tension and trigger points contributing to load patterns, particularly when calf or peroneal involvement is present. /dry-needling/
• Activity modification. Time-limited reduction of the triggering activity, with a clear return-to-activity plan rather than indefinite avoidance.

Treatments for chronic or persistent cases

When conservative treatment hasn’t fully resolved the bursitis, we have additional options on-site.

• Radial shockwave therapy. For chronic, stubborn bursitis, especially retrocalcaneal bursitis with coexisting insertional Achilles tendinopathy. Shockwave stimulates the body’s healing response and is an established second-line treatment for these cases. /shockwave-therapy/
• Corticosteroid injection therapy. Where indicated, a corticosteroid injection can reduce inflammation in persistent bursitis that hasn’t responded to conservative treatment. Most effective when combined with addressing the biomechanical drivers, so the bursitis doesn’t return.
• Surgical referral. Rare. Reserved for cases that have failed comprehensive conservative management or where a structural issue like a large Haglund’s deformity needs surgical correction. We work with orthopaedic and podiatric surgeons when referral is appropriate.

Many patients experience significant relief once the underlying biomechanical drivers are addressed alongside the symptomatic treatment. Outcomes vary depending on stage, compliance, and the underlying cause.