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Sunday, October 13, 2013

Bursitis: Email Advice

Hi Dr. Blake,

I have what seems to be a stubborn adventitious bursa under and around my fifth metatarsal that developed because my foot was very supinated. 

Dr Blake's comment: A bursae is a fluid filled sac that develops between the bone and soft tissue, deeper than a blister, in response to abnormal pressure. One can see from the video below that over supination will cause excessive pressure on the outside of the foot.

 I've been able to stretch and ease the peroneal tendons that seemed to be causing the supination.
Dr Blake's comment: As the foot supinates, or rolls to the outside, the peroneal tendons must be strong to stabilize. Focus you attention on strengthening the peroneal tendons. The video below emphasizes the peroneus longus exercise with the ankle in neutral. If you do the same exercise with the foot pointed downward, you will also get the peroneus brevis tendon. 

  The burae comes back with any type of pressure, even stretching.  
Dr Blake's comment: Once the bursae forms, even normal pressure can keep it irritated. I love deep ice massage three times daily to try to break it down, physical therapy with ultrasound and deep friction massage if self treatment is not successful, and injections or surgery if those are unsuccessful. You must off weight the area on a daily basis. You need a dancer's pad not for the first metatarsal, but for the fifth metatarsal. See my video from yesterday on using 1/8th inch adhesive felt from to create an off weighting system in all your shoes (great if you can attach this to your orthotic device). 

I'm wondering if cold laser therapy or some other treatment might help.  The bursa doesn't respond to cortisone, and it won't let me bicycle, even with orthotics.  Because it's on the bottom of my foot and is connected to other tissue, surgery probably wouldn't be a good idea.  Thanks in advance for your advice,


Dr Blake's comment: I like the old beating up of these bursae, and I have no experience with cold laser. I like, and have good results with cortisone shots when the icing and PT not help. The surgery is rare, so I would not go there right now. Get an MRI if it is stubborn to make sure you are really dealing with a bursae and not another cause of a soft tissue mass. Good luck!!

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.