Clinical aspects of bursae and tendon sheaths of the foot

Abstract

The evaluation and treatment of bursitis in the foot is a complex problem for the clinician. There is no one standard approach or set treatment for the patient who presents with pain suspected of being secondary to bursal involvement, primarily because there are myriad conditions and anatomical sites involved. Compounding this problem is the wide variation in the presence of these structures from patient to patient. Therefore, each distinct pathologic situation must be examined, diagnosed, and treated, based on its individual anatomical and etiologic factors. In the interest of completeness, the special anatomy of bursae and their specific pathologic conditions are reviewed.

Prognostic indicators of foot‐related disability in patients with rheumatoid arthritis: Results of a prospective three‐year study

“…The association between FFB and inflammatory disease has been previously documented in both histologic and cross‐sectional imaging studies (30–32). The identification of a synovial membrane within intermetatarsal FFB, with inwardly projecting villi (33), or a fibrocollagenous membrane that exhibits some superficial synoviocytic cellular elements (34, 35), appears to provide support for the notion that FFB are directly associated with disease activity. Additionally, a number of cross‐sectional imaging studies reinforce this theory, suggesting that the particular susceptibility of FFB, above other synovial structures, makes them a clinically useful and representative feature of minimal disease activity (32, 36, 37).…”

“…In such instances, mechanical FFB may be considered advantageous, allowing compression or torsion between otherwise densely fibrous, rigid tissues. The proposed etiology is mechanically induced separation of the fibrocollagenous tissues, resulting in the accumulation of extracellular fluid in these spaces (33). Future research that explores the underlying etiology or pathophysiology of FFB in patients with RA would clarify the identified link between FFB and disability and might provide information that leads to new treatment recommendations.…”

Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: A twelve‐month investigation

“…Conversely, adventitial bursae are defined as fluid‐filled spaces without a synovial lining, predominantly occurring within the plantar forefoot fat pad tissues (13). The adventitial bursae are considered mechanically derived, where abnormal shearing forces during gait result in collagen degradation and concomitant localized fluid collection at this site (14). When hypertrophied, anatomic intermetatarsal bursae appear on US as a well‐defined fluid collection with hypoechoic or anechoic zones usually bulging more than 1 mm under the metatarsal head level (15, 16).…”

Recalcitrant Lateral Premalleolar Bursitis of the Ankle Associated with Lateral Ankle Instability

“…In contrast, adventitious bursae develop in response to excessive friction [ 7 ]. Because the foot and ankle must bear weight and receive mechanical stress from the ground and are exposed to chronic stimulation by socks and shoes, the foot and ankle region is one of the commonest sites where an adventitious bursa may develop [ 8 ].…”