WHAT IS BURSITIS?
Bursitis is a painful condition that affects small fluid filled sacks called “bursae” that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed. This can happen anywhere in the body, especially the shoulder, hip and elbow. In the feet, it can occur in the toes, by the bunion joint and on the ball of your feet just to name a few.
Symptoms of Bursitis include stiffness and aching, pain upon palpation, and it can become swollen and red. Sometimes it is a challenge to diagnose Bursitis because it looks like an infection.
WHAT ARE SOME CAUSES OF BURSITIS?
The most common cause of Bursitis are repetitive motions or positions that put pressure on the bursae around a joint. Other causes include injury or trauma to the area and inflammatory arthritis such as Rheumatoid Arthritis or Gouty Arthritis.
Related to the foot, ill-fitting shoes are a big source of Bursitis, especially in the toes. Excess pressure on the bunion joint can also lead to a bursitis. Excess pressure on the ball of the foot can lead to bursitis in the lesser toe joints, where they meet the foot, typically on the bottom of the foot.
WHAT ARE SOME TESTS TO DIAGNOSE BURSITIS?
Since bursitis is a soft tissue fluid-filled sac, it will not show up well on a typical x-ray/radiograph. It can be visualized better using a Diagnostic Ultrasound machine, which shows soft tissue anatomy much better than x-rays. Going one step further, an MRI will be able to show a bursa but this test is usually not necessary. Many times, I am able to make the diagnosis by applying a side to side “squeeze” to the area and I can actually feel the bursa, which will usually elicit pain in my patient.
WHAT ARE SOME TREATMENTS FOR BURSITIS?
If I am dealing with a Bursitis on a toe, I am going to put a pressure reducing bandage around the bursa to keep pressure dispersed off of it. I am also going to apply Cortisone cream to the area and have the patient leave the bandage with Cortisone cream on for three days to help to reduce the inflammation. I am going to advise my patients to get longer shoes that have higher height in the toe box. I will also have them cut their shoe insole at the three-quarter mark to give more room for the toes. When making an Orthotic or Customized Insole for them, I will go three-quarter length as well to give more room for the toes in the front of the shoe. I will recommend orthopedic sandals to wear inside the house so that nothing is touching the toes or squeezing the toes. If the problem is severe, I will have them use orthopedic sandals out of the house as well.
Treatment for Bursitis on a Bunion consists of a pressure reducing bandage with Cortisone cream applied underneath and I instruct my patients to keep the bandage on for three days. I will also make recommendations on using orthopedic sandals inside the house and a longer, wider walking shoe for outside the house.
Treatment for Bursitis on the ball of the foot entails using pressure reducing bandages in the arch of the foot to take pressure off the ball of the foot, similar to a speed bump on a street. An Orthotic with these modifications built in is an important long term treatment for this problem so it does not recur.
Another basic treatment for Bursitis is to use ice on the area. The skin must be protected with a towel and then ice is applied for 10 minutes, then removed for 10 minutes then reapplied for 10 more minutes. This technique will reduce inflammation and swelling.
WHAT ARE SOME OF DR. RICHARD RIMLER’S SOLUTIONS?
Being a Holistic Podiatric Physician, I am going to use natural anti-inflammatories to treat cases of Bursitis due to their better safety profile. Examples of this are a strong 50 billion CFU Probiotic, Purified Fish Oil, Bioavailable Curcumin, or my favorite, Reuma-art (contains six natural ingredients in one capsule). The trick to dosing it is to go 2-3 times higher than what it says on the label for a few days and then to knock the problem out quickly and safely. Once the problem is resolved, the natural anti-inflammatory can be continued, but at the dose that it says on the label, which is a maintenance dose. I will not give the majority of these products to somebody that is on a blood thinning prescription medication. The only one that I would use in such an instance is a Probiotic (but taken in a higher dose than stated on the label) since that will not interfere with blood clotting.
If Rheumatoid Arthritis is the cause of the Bursitis, I will also impart dietary recommendation such as going “gluten-free”. Gluten is a glue-like substance found in all wheat products that gives flexibility. However, many people have
reactions to the gluten which then leads to an autoimmune reaction, which can then lead to over 100 autoimmune diseases, including Rheumatoid Arthritis. If gluten is the cause of the Bursitis, just by eliminating gluten from your diet, you can alleviate your symptoms. Gluten is found in bread, pasta, and pastries so alternatives need to be found. A great bread alternative is called sprouted bread, which is not inflammatory. An excellent pasta alternative is to use a bean or lentil based pasta or spaghetti squash. Switching to dark chocolate instead of pastries is a good alternative for dessert, besides fresh organic fruit.
If my patient has Rheumatoid Arthritis, I will recommend they see an Integrative Physician to help ascertain the root cause of the problem. Integrative Physicians will perform more extensive testing including stool and saliva tests to get to the cause of the reaction.
If Gouty Arthritis is the cause of their Bursitis, I will give recommendations on natural approaches to deal with Gout and its effect on the kidney, as well as making appropriate referrals to an Integrative Nephrologist. A few basic things to do for the kidney is adding lemon or lime juice to your water and drinking with a straw, which will alkalize your system. Another thing to do to improve kidney function is to put 1/4 of a teaspoon of Baking soda into a small glass of water and drink it daily. This will also alkalize your body and improve kidney function. Gouty Arthritis is related to the function of the kidney, your body may be producing too much or your kidneys may not be eliminating uric acid efficiently. This is a systemic problem that appears locally in the foot, but needs to be treated at the root cause of the problem, which often is the kidney.
Drinking diluted Tart Cherry Juice extract daily can also be very helpful to prevent Gout and lower uric acid levels. It is important to dilute the cherry juice with water otherwise it can be harsh on the system. I recommend a one-to-one ratio of water to Tart Cherry Juice.
Bursitis falls under the category of musculoskeletal disease and responds very well to my natural treatment approach. It is very important to get the right size and length shoes with ample room in the toe box. It is also important to use customized insoles or orthotics to provide stability to the foot and control motion.
I recommend that most of my patients take a 50 billion Probiotic daily and usually one other natural anti-inflammatory in order to keep inflammation down in your whole body. You will be helping reduce chances of pain in your feet, but you will also be reducing your chances of stroke and heart attack since inflammation is the cause of the majority of non-infectious disease. This is why I practice Holistic Podiatric Medicine.
I encourage you to book an office visit or teleconsultation so I can put you on a safe path to wellness. Any treatments mentioned should only be used after a one to one personal evaluation, do not start any kind of treatment without first consulting your doctor.
