Bursitis in the Feet: Causes, Types & Treatment
Foot bursitis is inflammation of a bursa — a small, fluid-filled sac that cushions where skin, tendon or muscle glides over bone. In the foot it most often flares at the back of the heel, under the ball of the foot, or over a bunion, producing a tender, localised swelling that hurts most when you press on it or wear tight shoes. In the great majority of cases it settles with rest, ice, padding and a change of footwear, and only rarely needs a procedure.
What a bursa is and what bursitis means
A bursa (plural: bursae) is a thin, slippery sac filled with a small amount of lubricating fluid. The body places these cushions at points of friction — for example between a tendon and a bone, or between bone and skin — so that tissues slide smoothly rather than rub. The human body contains more than 150 bursae. When a bursa is repeatedly irritated or compressed, its lining inflames and produces extra fluid, so it swells and becomes painful. That is bursitis. According to the Mayo Clinic, bursitis most often affects joints that perform frequent repetitive motion, and pressure or overuse is the usual trigger.
In the foot and ankle, several bursae sit in high-friction spots, which is why ill-fitting shoes, bony prominences and overuse so readily set off a flare. The good news is that, because the problem is mechanical, removing the source of pressure usually resolves it.
Common types of foot bursitis
Different bursae cause distinct patterns of pain depending on where they sit.
- Retrocalcaneal (posterior heel) bursitis. This bursa lies between the heel bone and the Achilles tendon. Inflammation causes deep pain at the very back of the heel, worse with running, climbing stairs or pushing off. It often travels with Achilles irritation and a bony heel bump (Haglund deformity).
- Subcutaneous calcaneal bursitis — the “pump bump”. This bursa sits just under the skin at the back of the heel, where a stiff shoe heel counter rubs. The result is a red, tender lump — common in people who wear rigid dress shoes, pumps or ski boots.
- Intermetatarsal bursitis. Inflamed bursae between the long bones in the ball of the foot cause burning or aching under the forefoot, sometimes mimicking metatarsalgia or a Morton's neuroma.
- Bunion (bunionette) bursitis. A bursa over a bunion at the base of the big toe — or a bunionette on the little-toe side — can swell and redden where the bump rubs the shoe.
Causes and risk factors
Most foot bursitis is mechanical — the result of friction or pressure — but it can also be inflammatory or, occasionally, infected.
- Friction from footwear: stiff heel counters, narrow toe boxes, and high heels that shift load onto the forefoot.
- Overuse: a sudden jump in running, walking or standing, or repetitive push-off in sport and dance.
- Bony prominences: a Haglund bump at the heel or a bunion that crowds a bursa against the shoe.
- Tight calf or Achilles: increased tension at the back of the heel.
- Inflammatory disease: gout and rheumatoid arthritis (RA) can inflame bursae directly; the NHS notes that conditions such as RA and gout raise bursitis risk.
- Infection (septic bursitis): uncommon, but a break in the skin can let bacteria into a superficial bursa — this is a medical emergency.
Symptoms and how it is diagnosed
The hallmark of bursitis is a soft, often visible swelling that is tender to direct pressure. Typical features include:
- Localised swelling over the affected bursa, sometimes warm to the touch
- Pain that worsens when you press on the area or wear shoes that rub it
- Stiffness or aching when you first move after rest, easing a little as you warm up
- Redness over the skin, especially with a pump bump or bunion bursa
Diagnosis is usually clinical: a clinician examines and palpates the foot, asks about your footwear and activity, and checks for the bony bumps or tight tendons that drive it. Imaging is not always needed, but an ultrasound can confirm a fluid-filled bursa, and an X-ray may reveal an associated Haglund deformity or bone spur. If gout, RA or infection is suspected, fluid may be drawn for testing. The American Academy of Orthopaedic Surgeons emphasises distinguishing bursitis from tendon problems, because the treatment emphasis differs.
Treatment and self-care
First-line care follows the familiar pattern of reducing load and calming inflammation. The American Podiatric Medical Association and Mayo Clinic both recommend conservative measures first.
- Rest and activity change: cut back the aggravating activity for a week or two; swap running for low-impact cross-training.
- Ice: apply a wrapped cold pack for 10–15 minutes a few times a day to ease swelling.
- Footwear changes: roomier, softer-backed shoes; open-back styles for a heel pump bump; a wide toe box for a bunion bursa; lower heels to offload the forefoot.
- Padding and offloading: gel heel pads, doughnut-shaped pads around a pump bump, or metatarsal pads for forefoot bursitis. Supportive insoles or orthotics can redistribute pressure.
- Stretching: gentle calf and Achilles stretches reduce tension at the back of the heel.
- NSAIDs: short courses of over-the-counter anti-inflammatories (such as ibuprofen) can relieve pain — check they are suitable for you.
- Procedures: if conservative care fails, a clinician may aspirate fluid or give a corticosteroid injection. Surgery to remove a bony prominence is reserved for stubborn cases.
| Type | Where it hurts | Key self-care |
|---|---|---|
| Pump bump | Back of heel, skin level | Open-back or soft-heel shoes, doughnut pad |
| Retrocalcaneal | Deep at heel/Achilles | Heel lift, calf stretch, lower-heel shoes |
| Intermetatarsal | Ball of the foot | Metatarsal pad, wider toe box |
| Bunion bursa | Side of big/little toe | Wide shoes, bunion shield, padding |
Prevention, and how bursitis differs from tendonitis
Prevention is mostly about reducing friction and load. Choose shoes with a comfortable, non-rigid heel counter and enough room in the toe box; avoid long stretches in high heels; increase running or walking mileage gradually; keep the calves supple; and address bunions or a Haglund bump early before they irritate a bursa. If you have gout or rheumatoid arthritis, managing the underlying condition lowers your risk of flares.
People often confuse bursitis with tendonitis, particularly at the heel. The distinction is useful: bursitis tends to produce a soft, pressure-tender swelling and hurts most when something presses on it, whereas tendonitis hurts when you load or move the tendon — for example rising onto your toes. At the back of the heel the two frequently coexist, which is why a professional assessment helps target treatment. If pain persists beyond a few weeks, recurs, or you are unsure what is driving it, it is worth seeing a clinician — see our guide on when to see a podiatrist.
Frequently asked questions
- What is the difference between bursitis and tendonitis in the foot?
- Bursitis is inflammation of a bursa, a small fluid-filled cushioning sac, and tends to cause a soft, localised swelling that hurts most with direct pressure. Tendonitis is inflammation of a tendon and usually hurts when you move or load that tendon, such as pushing off or rising onto your toes. The two often overlap at the back of the heel, where both the Achilles tendon and the retrocalcaneal bursa can be involved at once.
- How long does foot bursitis take to heal?
- Most cases of foot bursitis settle within a few weeks once the friction or pressure is removed and you rest, ice and adjust your footwear. Stubborn or recurrent bursitis can take several weeks to a few months, especially if a bone spur, a bunion or a tight Achilles is driving the irritation. Persistent swelling beyond six weeks warrants a professional review.
- Should I drain bursitis in my foot at home?
- No. Do not try to drain or puncture a swollen bursa yourself, as this risks introducing infection. Aspiration, if needed, should only be done by a clinician under sterile conditions. Seek urgent care if the area becomes hot, red, very painful or you develop a fever, as an infected bursa needs prompt medical treatment.
Sources & further reading
- Bursitis overview, symptoms and causes, Mayo Clinic
- Bursitis self-care and when to get help, NHS
- Foot and ankle conditions, American Academy of Orthopaedic Surgeons (AAOS)
- Foot health and podiatry care, American Podiatric Medical Association (APMA)