Ankle Bursitis: What It Is and How To Treat It

Ankle bursitis or swelling of the bursae (fluid-filled sacs) in your ankle can show up in active folks—runners, hikers, or people in physically demanding jobs. Statistically speaking, elbow and ankle bursitis can occur in one in 10,000 people each year, partly due to bacterial infection. In Singapore, this injury is classified as frictional, chemical, or septic bursitis, determined through its cause.

This article delves into ankle bursitis specifically, covering its symptoms, causes, diagnosis, and treatment. Understanding the key facts helps distinguish this condition from other similar injuries.

What Is the Ankle Bursa?

The ankle bursa is a small, sac-like structure that cushions and reduces friction between bones, tendons, and muscles around the ankle joint. It helps ensure smooth movement and prevents irritation. The ankle region contains major bursae, such as the retrocalcaneal bursa and the subcutaneous calcaneal bursa, which protect the Achilles tendon and heel bone. There are different types of bursae classified based on location.

Different Types of Bursae

Bursae reduce friction and cushion the ankle, which are classified by their location. Each plays a critical role in maintaining smooth, pain-free ankle movement, but they are also prone to inflammation due to overuse, injury, or prolonged pressure. Key examples include the following:

• Subcutaneous Bursa (located just beneath the skin) – cushion against external pressure or impact; important in protecting areas that frequently experience rubbing or pressure from tight footwear.
• Retrocalcaneal Bursa (between the heel bone and the Achilles tendon) – minimises friction during activities like walking or running; inflammation here is common in athletes or someone with tight calf muscles.
• Achilles Bursa or Subcutaneous Calcaneal Bursa (at the back of the heel, between the skin and the Achilles tendon) – protects the area from pressure caused by ill-fitting shoes; often becomes inflamed alongside the retrocalcaneal bursa, causing Achilles tendon bursitis.

What Is Ankle Bursitis?

Ankle bursitis occurs when the ankle bursa becomes inflamed, leading to pain and swelling in the joint. The most common types are retrocalcaneal bursitis and Achilles bursitis, which affect the back of the ankle. This painful condition often results from overuse injuries, direct blows, or poorly fitting shoes. Physiotherapy treatments for ankle sprain and ankle bursitis can overlap as both conditions involve reducing inflammation, restoring mobility, and strengthening the joint.

What Are the Symptoms of Ankle Bursitis?

Ankle bursitis symptoms vary depending on the type—Acute Bursitis or Chronic Bursitis—each presenting unique characteristics. Acute bursitis typically results from injury, trauma, infection, or joint disease. Symptoms include:

• Severe pain and intense discomfort when moving the ankle or pressing on the affected area
• Pain often limits the ankle’s range of motion, making walking or flexing difficult
• The skin over the bursa may feel warm and appear red, sometimes accompanied by swelling
• Pain worsens when the affected area is touched or pressed
• Muscle pain during movement
• If caused by infection, septic bursitis may cause skin temperature to rise significantly, up to 2.2°C above normal

Meanwhile, chronic bursitis stems from repetitive micro-injuries or prolonged pressure on the ankle. Over time, the bursa adapts by gradually expanding, leading to symptoms such as:

• Swelling and noticeable puffiness around the ankle, particularly near the heel
• Thickened bursa, becoming dense and more prominent
• Pain is typically less severe or even absent compared to acute cases
• Restricted joint movement due to the swollen bursa
• Ankle pain, particularly around the affected bursa
• In severe cases, chronic pain and restricted mobility
• Heel pain and pressure are also common symptoms specific to ankle bursitis.

What Causes Ankle Bursitis?

Ankle bursitis often results from trauma, overuse, or infection. Repetitive motions, such as running or jumping, commonly irritate the bursa, while tight or poorly fitting shoes, like high heels, add excessive friction and pressure to the area. Underlying conditions, such as rheumatoid arthritis or gout, further increase the likelihood of bursa inflammation. Prolonged stress on key areas, like the heel bone or medial malleolus, can also trigger this condition. It can share similar causes with heel bursitis and other types. Since the causes can vary and overlap, obtaining a professional diagnosis is essential to identify the root issue and develop an effective treatment plan.

Who Is More Prone to Developing Ankle Bursitis?

Anyone can develop ankle bursitis, but certain groups are at higher risk.

• Athletes or individuals with repetitive stress on the ankle
• Those with ill-fitting shoes or poor foot support
• People with pre-existing conditions like Haglund’s deformity or arthritis
• Occupations requiring prolonged standing or walking

How Is Ankle Bursitis Diagnosed?

A doctor can diagnose ankle bursitis through a physical exam and medical history and may also order imaging or lab tests. Each process can involve the following procedures:

1. Medical History: Evaluating symptoms, lifestyle, and potential triggers like overuse or injury
2. Physical Examination: Checking for swelling, redness, warmth, tenderness, and limited joint movement
3. Imaging Tests: X-rays, ultrasounds, or MRIs help confirm inflammation and rule out fractures or other conditions
4. Aspiration: In cases of suspected infection, fluid may be drawn from the bursa to check for bacteria or other abnormalities

A thorough diagnosis ensures the condition is properly treated and not mistaken for similar injuries.

How Is Ankle Bursitis Treated?

Treatment for ankle bursitis focuses on reducing pain and inflammation, all while addressing the root cause. Here are techniques and modalities experts find effective.

Exercise

Strengthening exercises, along with proper warm-up and cool-down routines, help reduce pain and prevent further strain on the ankle. Phoenix Rehab in Singapore provides a personalised treatment plan and targeted exercises tailored to your needs.

Physical Therapy

An experienced physical therapist can guide rehabilitation exercises to strengthen the Achilles tendon and improve ankle joint stability.

Medication

Over-the-counter pain relievers like ibuprofen can reduce swelling and relieve pain.

Injections

Corticosteroid injections may provide temporary pain relief in severe cases. Prolotherapy, which stimulates healing, is another option for chronic conditions.

Surgery

Surgical interventions like fluid drainage or bursa removal may be necessary for severe cases or when infections persist.

What Can Be Done at Home for Ankle Bursitis?

In most cases, ankle bursitis can be treated effectively at home with the following methods:

Rest, Ice, and Elevation

Apply ice to reduce swelling, elevate the ankle, and rest to allow healing.

Modifying Daily Activities

Avoid activities that place stress on the affected bursa, such as running or prolonged standing.

Wearing Better Shoes

Proper footwear, including shoe cushions and custom heel wedges, helps reduce friction and pressure on the heel bone.

When To See a Doctor

Seek medical advice if ankle bursitis pain persists, swelling worsens, or signs of a possible infection like fever occur.

Is a Full Recovery From Ankle Bursitis Possible?

While there isn't a "cure" per se for ankle bursitis, most cases can be effectively managed and resolved with conservative treatments. Full recovery is possible with proper treatment. Mild cases may heal on their own with conservative treatment, while more severe conditions might take weeks to months. Adhering to care routines and dos and don'ts can prevent recurrence.

Conclusion

At-home interventions, exercise, and physical therapy are powerful methods to fully recover from ankle bursitis, especially when strategically incorporated into your routine. Early treatment, proper care, and addressing the underlying cause are crucial to prevent long-term issues. If the pain is severe or doesn't improve with home care or a bacterial infection is suspected, see your doctor immediately.