Trying to distinguish between plantar fasciitis and other types of heel pain can be difficult, and you even may have more than one of these syndromes working on you at the same time. Bursitis is one of those conditions.
What is Plantar Bursitis?
A bursa is a small sac of fluid usually found where tendons or ligaments (soft connective tissue) attach to bone. There are anatomic bursae (bursae that most people have) and there are some acquired bursae (bursae that some people develop due to high pressure or tension at an area of soft tissue attachment to bone).
When these sacs become inflammed, we call that bursitis. Plantar Bursitis is an inflamed sac of fluid under the heel.
X-ray with heel spur
What Causes Plantar Bursitis?
Plantar Bursitis is usually an overuse syndrome such as tendonitis.
The heel bone is protected from overuse injury by the plantar fat pad. A bursa forms as an extra layer of cushion when the bone is inadequately protected. ï»¿Bursitis happens when the bursa becomes inflamed.
There are other factors that vary by person to consider: Some people may walk and run with excessive heel strike. Other people may have a thin fat pad. Others may have a heel spur creating extra pressure to the fat pad.
Ultrasound with bursa
What are the symptoms of Plantar Bursitis?
Bursitis of the plantar aspect of the heel usually includes the following symptoms:
- Minimal to no pain with first steps in the morning or after sitting
- Pain that worsens the longer you are on the foot
- Bruised or swollen feeling on the bottom of the heel
- Redness to the bottom of the heel
- Pain is worse barefoot or with heeled shoes
How can you tell the difference between Plantar Fasciitis and Plantar Bursitis?
In our office we take X-rays of the foot and heel as part of our evaluation. Often an X-ray may show a heel spur. Heel spurs on the bottom of the heel are often associated with both Plantar Fasciitis and Plantar Bursitis.
The best way to tell is with an ultrasound image of the bottom of the heel. Ultrasound is a simple, 5 minute imaging test that is available in most podiatry offices. We use ultrasound in our office.
Ultrasound images clearly show the fluid sac if it is present, as in the example above.
How is Plantar Bursitis treated?
The following have been show to be effective against Plantar Bursitis:
- Ice massage
- Anti-inflammatory medicines like ibuprofen, naproxen or aspirin
- Horsheshoe shaped heel pads
- Cortisone injections
- Accommodative shoe inserts
- Rarely surgery is needed to excise the bursa or remove an associated heel spur
If you still have questions or are unsure of what your foot condition is, see a Podiatrist. In or near Mesa, Arizona, schedule an appointment with Dr. Clement.
For more tips about how you can treat Plantar Bursitis, see our Self-Treatment Page.