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Masashi Naito [1] and Takumi Matsumoto [1] and Song Ho Chang [1] and Masachika Ikegami [1] and Jun Hirose [1] and Sakae Tanaka [1]
Academic Editor: Koichi Sairyo
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan, u-tokyo.ac.jp
Received May 24, 2017; Accepted Jul 9, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
A bursa is a cyst lined with synovial cells and located in an area exposed to high pressure or repetitive friction. Bursitis is the inflammation of the bursa mainly caused by excessive mechanical stimulation and by other reasons including autoimmune inflammatory diseases, trauma, and infection. Some bursae located adjacent to joints may have communication with joints. Such bursae are termed as communicating bursae and have been reported to occur around the hip, knee, and shoulder joints [1–3]; however, there is no report in the English literature regarding communicating bursae around the ankle joint.
The foot and ankle region is one of the commonest sites of bursitis because it is subject to mechanical stress from the external environment. Lateral premalleolar bursitis, known as an occupational bursa among floor layers in Western countries, is not uncommon among the general population in Asian countries where sitting on the foot is popular [4]. Most cases of bursitis are managed conservatively with methods such as local protection against stimuli, aspiration, a compressive wrap, and corticosteroid injection [5]. Operative excision is performed for recurrent and symptomatic cases unresponsive to conservative treatments.
Here we report a case of repetitive lateral premalleolar bursitis resistant to conservative treatment, which was revealed as a communicating bursa associated with ankle instability.
2. Case Report
A 66-year-old woman complained of an intractable swelling of the right ankle and difficulty in wearing shoes on the affected side because of the swelling. She had a medical history of type 2 diabetes, hypertension, and dyslipidemia. The patient had become blind due to diabetic retinopathy at the age of 35 years. After an inversion sprain of her right ankle which occurred two years previously, which was treated conservatively by her local doctor, she began...