25 Mar Commonly Injured structures in the foot from running #1 – Bursa
This will be an ongoing series of blogs relating to – Commonly Injured structures in the foot:
What is a bursa and what is its function?
A Bursa is a “sac” of fluid that provides a buffer between two anatomical structures be that bone on tendon or bone on bone. This structure is important as it basically protects two structures from rubbing against each other.
An example of a bursa protecting bone and tendon is the retro-calcaneal bursa. This bursa is located between the antero-inferior wall of the Achilles tendon and the posterior surface of the calcaneum (heel bone).1 It lies in the region of the Achilles tendon insertion into the calcaneus with its function to reduce friction associated with the tendon’s movement in surrounding tissue.1 Inflammation of the bursa is common and results in pain, tenderness and swelling.1 Retro-calcaneal bursitis is an important differential diagnosis to Achilles tendinopathy (mentioned earlier) to consider but can also often occur in combination.2
Another example of a bursa that protects bone on bone is the inter-metatarsal bursae which lie between the adjacent metatarsophalangeal joints in the feet. These bursa protect the adjacent metatarsal heads from rubbing against each other in particular from compression forces when wearing closed in shoes. They can be damaged for example if your running, work or casual shoes are too narrow. With continual compression of the bursa they can become inflamed, enlarged and painful with a condition called inter-metatarsal bursitis. A secondary effect of the now enlarged bursa, in particular between the 2nd and 3rd web spaces, is that it can compress a closely coursing nerve. This can consequently cause an inflammation of the nerve (a neuritis) in a condition referred to Morton’s neuroma.
References and Further Reading
1 PĘKALA, P. A. et al. The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study. Bone Joint Res, v. 6, n. 7, p. 446-451, Jul 2017. ISSN 2046-3758. Disponível em: < https://www.ncbi.nlm.nih.gov/pubmed/28765268 >.
2 SCHEPSIS, A. A.; JONES, H.; HAAS, A. L. Achilles tendon disorders in athletes. Am J Sports Med, v. 30, n. 2, p. 287-305, 2002 Mar-Apr 2002. ISSN 0363-5465. Disponível em: < https://www.ncbi.nlm.nih.gov/pubmed/11912103 >.
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