Friday Q&A: Ankle Bursitis

By Ninazolotow @Yoga4HealthyAge

OK by Melina Meza

Q: I finally got my balance back (after [a] stupid fall) and I [have been] a walking FIEND! Then... the bursa in my right inside ankle went ka-blooey. Hurts like hot coals. Can stand on it and I can walk - but it HOITS! Is there anything I can do within the realm of yoga to help alleviate this?
A: There sure is something that yoga can do about this, and I will get that soon. But let’s quickly review a couple of topics first. A “bursa” is a fluid filled sac that is found around moving joints throughout the body. They have a cushioning role between structures, mostly between tendons and bones, but also between bones and skin. Their healthy state also allows for smooth movement of the tendons and muscles over boney prominences and between other muscles and tendons.
“Bursitis” is when a healthy bursa becomes inflamed and swollen. This can lead to localized pain, as well as interfering with the normal movement of the structures it usually helps to move more smoothly! As a result, when the bursa become inflamed you end up with a limited range of motion in the corresponding joint. This is particularly true in the hip area (see Friday Q&A: Yoga and Bursitis) and the shoulder area.
Our reader has a less common bursitis somewhere around her ankle. Although she does not specifically state where on the ankle, the most common spot in that vicinity is the bursa at the back of heel, which is in between the heel bone (the calcaneus) and the thickest tendon in the body, the famous Achilles tendon). Technically, this bursa is called the “retrocalcaneal bursa—that makes sense as “retro” means behind. I love it when these names tell you where they are located.
I should also mention that inflammation of this bursa could cause localized pain at the back of the heel but also referred pain to the ball of the foot, the bottom of the heel, or the top of the foot near the toes. The pain can arise while walking, running, or jumping, or when pressing on the back of the heel bone, and can worsen when lifting the heels and balancing on the balls of your feet. For some people, the opposite movement, dorsiflexion of the ankle, like the back leg ankle in Warrior 1 Pose, may make the pain worse.
When the bursa is really inflamed, the area itself may swell and the skin my turn red and be warm to touch.
It is know that repetitious movements or too much use of the ankle can cause the bursa to become irritated and inflamed. Certain activities, such as too much walking, running or jumping, are possible causes. I suspect having become a “walking fiend” may have played a role in our reader’s bursitis. To confuse things a bit, this form of bursitis is very often linked with Achilles tendonitis (inflammation of the tendon that attaches the large calf muscles to the heel bone near the bursa). This can sometimes make the diagnosis a bit tricky, so see your doc to get clear on what is happening here!
According to the National Institutes of Health, the risks for ankle bursitis include starting a very intense workout schedule and suddenly increasing activity level without the right conditioning. Western medical treatment includes the following:
  1. Avoid activities that cause pain.*
  2. Put ice on the heel several times a day.
  3. Take nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen.
  4. Try using over-the-counter or custom heel wedges in your shoe to help decrease stress on the heel.*
  5. Try ultrasound treatment during physical therapy to reduce inflammation.
  6. Have physical therapy to improve flexibility and strength around the ankle. This can help the bursitis improve and prevent it from coming back. *
In extreme cases that are unresponsive to the above recommendations, a steroid injection into the bursa is sometimes used. This can be tricky for yogis, as the shot can weaken the tendon, putting you at risk of tear or rupture when stretched. But, generally, with more typical cases of ankle bursitis, the condition often gets better in several weeks following the above recommendations.
The asterisks in the above list are mine and indicate areas where you can use your yoga practice to assist in the healing process. Our goal is to allow the bursa to settle down and resolve the inflammation back to the pre-bursitis state. Here are my additions to the recommendations with asterisks.
1. It is quite possible in this instance that you should scale walking back until the pain resolves, and any active yoga practice, specifically strong vinyasa practices, would need to be temporarily modified as well. But other yoga asana approaches can be implemented and continued through the healing process. Maintaining range of motion of the ankle joint is generally helpful in keeping the joint healthy over time, so non-weight bearing movement of the ankle and foot, such as when your leg is up in the air in Reclined Leg Stretch pose or Legs Up the Wall pose, or in Seated Ankle Circles could help you maintain ROM. 
Inverted poses, such as Legs Up the Wall, could help in the acute setting to reduce swelling around the ankle, which could help reduce pain. 

4. In addition to appropriate inserts in your shoes, if weight-bearing activity is tolerable and you want to do some standing poses, such as the Warrior series or Triangle and Extended Side Angle poses, the use of a wedge to lift either the ball of the foot or the heel of the foot may permit you to do those poses without triggering pain and permit some safe strengthening of the muscles around the ankle at the same time.
6. Just as Physical Therapy can prescribe exercises for strengthening and stretching the ankle, so many of our yoga postures will have similar benefits. A well-balanced yoga asana practice that includes reclining, seated, and standing postures, even very basic ones, can do just that. Our Lower Body Strength Practice and Lower Body Flexibility Practice could be a good place to start, once swelling and pain have mostly resolved.
What’s that old saying, an ounce of prevention is worth a pound of cure? Western medical preventive strategies include:
  • Use proper form when exercising. (Many, but not all, yoga styles can support this, for example, Iyengar style)
  • Maintain good flexibility and strength around the ankle to help prevent this condition. (As stated above, yoga does a great job with these goals!)
  • Stretch the Achilles tendon to help prevent injury. (Yoga ditto!)
  • Wear shoes with enough arch support to decrease the amount of stress on the tendon and inflammation in the bursa.
Just as yoga helped our reader improve her balance, with good guidance from a local teacher and keeping some of the recommendations above in mind, yoga can also assist her in healing her ankle bursitis, too! 

—Baxter
Disclaimer: This article is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities. 


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