When an Injury Leads to an Injury Which Leads to Bursitis

I recently shared an article about my emergency spinal surgery last fall and how the required adaptations following that procedure required me to avoid bending or twisting at the hips for nearly 3 months post-op. However, the way I maneuvered my body during that time led to 3 broken bones in my left foot and 3 months in an aircast.

I really wish the story ended there.

Continued complications after RA surgery

During the time I was forced to wear an aircast, I felt a lot of pain throughout my body. First, my gait changed, making walking painful and putting additional strain on my hips, pelvis, and sacrum. Despite trying topical BioFreeze, chiropractic adjustments, ice, and heat, I couldn't relieve the pain.

Second, the pain in my foot improved, but much slower than anticipated. I was disappointed when the original 4-6 week estimate for wearing the aircast kept getting pushed out. This happened because I'm immunosuppressed due to Remicade and steroid-dependent because of Adrenal Insufficiency.

Third, when I started trying to walk regularly in shoes again, I felt pain in a new place.

I had developed bursitis

My doctor ordered another MRI of my foot, which was my third one since the injury was first identified. He had both good and bad news for me. The fractures had healed, and I could stop wearing the aircast. Great! I exhaled.

But then he said - the pain you're feeling, it's a new injury due to being in the aircast for so long. It's called intermetatarsal bursitis.

How did this happen?

This is when I learned about bursae - small, closed, fluid-filled sacs that cushion our bones, tendons, and muscles to allow our joints to move without friction or rubbing¹. In my case, the bursae between the metatarsal bones in my foot had become irritated and inflamed due to the positioning and pressure exerted on them during my time in the aircast. They were now causing a significant amount of pain in the ball of my foot when trying to walk barefoot or when moving my foot in certain directions. I had 4 distinct pockets of bursitis, all visible on the MRI images.

My podiatrist shared that bursitis would typically respond well to conservative treatments like frequently icing and elevating, taking NSAIDs, and adding metatarsal pads to my shoes. However, in my case, he wanted to move forward with something more aggressive - cortisone injections. Based on the amount of time I'd been in the aircast and the severity of my symptoms, he felt like the inflammation would stick around far longer than we'd like, and I needed to be able to rehab my foot, hips, and back after being in the aircast for so long.

Although painful, I'm happy with my treatment

When I went to his office for the injections, I learned that bursitis (along with tendonitis) is also called soft tissue rheumatic syndrome, and living with RA slightly increases the risk of experiencing these conditions. I have to be honest, those 4 cortisone injections were some of the most painful injections I've ever received, and I've been on both IV and intramuscular injection therapy for RA.

I regularly use intramuscular injections to stop migraines and have done nearly 1,000 subcutaneous and intramuscular injections for In Vitro Fertilization (IVF). The challenge with the cortisone injections was that there is no padding in the foot surrounding the bursae, so no fat or muscle to help absorb the pain. The inflammation from the bursitis is already intense, and sticking a needle directly into the fluid-filled sac is extremely painful. The doctor also had to put direct pressure on both the top and bottom of the bursae while injecting to hold it in place.

Suffice it to say, he had to lean my chair back and remind me to breathe until the color returned to my face.

It's been about 3 weeks since the injections, and while I still ice my foot a few times a week and wear metatarsal pads in my shoes both inside and out, overall, the pain is much improved, and I'm grateful we moved forward with the more aggressive treatment option.