Retrocalcaneal bursitis is the inflammation of the fluid filled sac located between the heel bone and the Achilles tendon. You may have severe pain and swelling in the heel. When working with subortholene or other plastics and ortbltics, one of the main problematic fit points is in the heel as the rigidity (2mm or >) will be so stiff that the insert can kick within the shoe, causing friction, irritation, and apparently bursitis. To fill in the gap, I used a 6mm 55 duro EVA from #Acor on the hard side but perfect for patch jobs like this. There are topical NSAIDS that may help, too. Appling ice to the heel for 20-30 minutes, 3-4 times a day. Most clinicians go with a standard rule that no more than three different injections should be used in one area of the body within a twelve-month period. Tape the bursa using a donut shaped pad to help alleviate some of the pressure caused by wearing your shoes. More to follow. This inflammation results in exquisite tenderness along the posterior aspect of the heel and . Most patients with retrocalcaneal bursitis heal well with appropriate physiotherapy. It is usually a result of repetitive movements causing minor trauma to the area, including running and jumping. Retromalleolar tendon bursitis. Bursitis can develop in either the retrocalcaneal bursa and the calcaneal bursa. Wearing soft shoes with heel and arch support. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. J Foot Ankle Surg. Swelling and redness on the back of your heel. 2010 May-Jun. One of our lovely customer has been doing much more walking thanks to our current Covid19 situation. When engaging in these exercises, a gradual increase should be done in order to revert back to the level of functioning prior to the development of the issue in a pain-free manner. The most common symptom of retrocalcaneal bursitis is pain and tenderness around the back of the heel. Crocs are the perfect shoes for retrocalcaneal bursitis. Other symptoms may include redness and warmth around the affected area. Repeated or too much use of the ankle can cause this bursa to become irritated and inflamed. Given that the injection may be painful upon initiation, many professionals will administer the anesthesia separately to ensure a higher level of comfort prior to the bursitis foot cortisone injection. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the. Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. While rare, there are surgical interventions that may be used to help individuals with severe cases of retrocalcaneal bursitis. You should consult with a physical therapist for a customized exercise plan that meets your individual needs. Retrocalcaneal bursitis is a medical condition that causes heel pain. When this bursa becomes aggravated and inflamed it creates significant pain on the back of the heel. Retrocalcaneal bursitis happens when the bursae around your heel become inflamed. In general, people experience warmth and swelling in the afflicted area. Report Thread. This pain spreads from the bursa located between the Achilles tendon and the heel bone. He notices that the pain is most pronounced when arising from a seated position or when arising from bed in the morning. Sofka CM, Adler RS, Positano R, Pavlov H, Luchs JS. Schedule an appointment, make an inquiry or send your comments. The muscle group at the back of the lower leg is commonly called the calf. Wearing shoes and being active can often make symptoms worse. This pain spreads from the bursa located between the Achilles tendon and the heel bone. Treatment is aimed at reducing the pain and swelling, with the goal of gradual return to activity. Try . The diagnosis and treatment of heel pain: a clinical practice guideline revision 2010. The harder the back on your high heeled shoes can also increase the external compression as well. A bursa anatomically is a fluid filled . Bursae are fluid-filled sacs that form around your joints. Inflammation of either or both of these bursa can cause pain at the posterior heel and ankle region. Symptoms Pain and swelling over the back of the heel Retrocalcaneal or Heel Bursitis occurs when the retrocalcaneal bursa becomes inflamed and painful. If you would like to link to this article on your website, simply copy the code below and add it to your page: Return to the top of Retrocalcaneal Bursitis. Learn the treatment options. As time progresses, you may then increase the intensity and the overall frequency of the exercise program to recover from the condition. Retrocalcaneal bursitis symptoms usually improve within about eight weeks with home treatment. Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis. Two bursae are located just superior to the insertion of the Achilles (calcaneal) tendon. We offer FREE shipping, FREE exchanges, EASY returns and a 100% Price Match Guarantee! Retrocalcaneal Bursitis Anatomy. Open-backed shoes may be worn to alleviate pressure placed on the heel. In some cases, tight shoes can compress the bursa, causing it to inflame, while blunt trauma such as a kick to the heel while playing sport can also cause Retrocalcaneal Bursitis. 2. It is inflammation and swelling of a bursa at the back of the heel. 30(4):347-53. There are many symptoms of retrocalcaneal bursitis, with the most common being pain in the heel. I went to a PT and do the stretches he recommended. As time progresses, you will be able to work more independently. The Achilles tendon joins into the back of the heel bone and injury to this tendon at the insertion causes bursitis. Retrocalcaneal bursitis occurs when the bursa becomes inflamed as a result of the Achilles tendon rubbing over the bursa and causing friction against the heel bone. Inflammation of the Retrocalcaneal bursa is most commonly caused by overuse or repetitive trauma.It can also be aggravated by pressure, for example, from tight-fitted athletic shoes. Achilles tendon bursitis, retro achilles bursitis, heel bursitis, back of heel pain, swollen back of heel, painful heel. Thank God for Dremel ?. This pressure can cause wear and tear of the bursa causing microtrauma. When the patient's situation worsens, the last conservative care step before surgery to be considered is cortisone injections. There are several factors which can predispose patients to developing this condition. Management of retrocalcaneal bursitis is aimed to reduce the pain and swelling and reduce pressure on the bursa. Understanding Retrocalcaneal Bursitis. College Running. HSS J. You may also notice tenderness when the heel is touched. Standing on your toes, calf-targeting exercises, and pressing on the area might also increase the pain. A bursa is a small fluid filled sack that provides cushioning in areas where tendons pass over bones. Symptoms: Pain at the back of the heel bone, especially the edges of the heel bone. Over time this can cause thickening of the bursa, inflammation and bursitis. Symptoms normally include a constant dull ache or burning pain at the back of the . 2012 Jul. Click here to visit our page dedicated to treating Insertional Achilles Tendonitis that has video tutorials on strengthening, footwear and other treatments. This may include further investigations such as an ultrasound, X-Ray, MRI or CT scan, pharmaceutical intervention, corticosteroid and anaesthetic injection into the retrocalcaneal bursa, draining of the bursa, or review by a specialist or podiatrist who can advise on any treatment that may be appropriate to improve the condition. Doorbusters for 50% off are first come, first serve so don't wait to stop in. If you have recently started an intense workout regimen (such as training that includes uphill running) and are experiencing heel pain, it could be due to Retrocalcaneal bursitis. Due to the fact that Crocs do not have a heel to their shoe, they do not irritate the bursitis and pain never results. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. $219.95 . . Treatment may comprise: Despite appropriate physiotherapy management, some patients with retrocalcaneal bursitis do not improve adequately. Here we explain the symptoms, causes, and treatment of Achilles bursitis. Progressive treatment with Theta Orthotics begins at a tolerable but helpful correction. Bursa are small sacs that surround the joints and are filled with fluid. This type of bursitis forms in your heel, making it difficult to stand and walk. You may hear a crackling sound when you flex your foot. Retrocalcaneal bursitis is a medical condition that occurs when the bursa located around the heel of the foot experiences inflammation. When this bursa becomes aggravated and inflamed it creates significant pain on the back of the heel. A doctor may recommend the use of custom heel wedges and/or a steroid injection. This inflammation can occur after an injury to the area, and it can also occur gradually as a result of repetitive trauma to the bursa from running, jumping or any activity that causes pressure on the heel. Shop a wide variety of Doctor Recommended Bursitis Footwear at Healthy Feet Store! Treatment of the pain and inflammation can include the following steps: Resting from activities that exacerbate symptoms. Arthroscopy. Over the last few weeks, she noticed an irritation and protrusion round the medial ankle. Retrocalcaneal bursitis is an inflammation of the bursa at the back of the heel bone. Often pain may be worse with rest after these activities (especially that night or the following morning). These are near the heels of the feet, immediately behind the Achilles tendon. It usually happens in athletes as shoes rub against the heel. Some types of shoes may become difficult to wear. Please enter a search term relevant to the search type. Most doctors will administer those that are considered long-duration, which means that they take effect within one to three weeks and the benefits actually last up to nine months. The physician may perform imaging studies such as an x-ray or ultrasound. Clin Rheumatol. Septic bursitis Achilles bursitis refers to inflammation of the fluid filled sack called a bursa that lies between the Achilles tendon and the back of the heel bone (calcaneus). Clinical anatomy of the retrocalcaneal bursa. For US States - use only letter abbreviations. Changing your shoes. Over the last few weeks, she noticed an irritation and protrusion round the medial ankle. Kachlik D, Baca V, Cepelik M, et al. Causes include 2,5: calcaneal tendon injury: rupture or tendinitis. Retrocalcaneal bursitis refers to a condition which involves the inflammation of the bursae around the heel. The pain may worsen with activities such as walking, running, or climbing stairs. Other causes include: Retrocalcaneal bursitis is treated in numerous ways. Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. You may find that your heel region hurts if you stand on the tip toes. Surgical treatment of chronic retrocalcaneal bursitis. Retrocalcaneal bursitis is a condition that affects the bursae of your heels. They are right above where this tendon attaches to the bone of the heel. Retrocalcaneal refers to the back (retro-) of the heel bone (calcaneum). The definition of bursitis is an inflammation of a fluid-containing sac (bursa) which is located between a bone and tendon. It is usually a result of repetitive movements causing minor trauma to the area, including running and jumping. Severe pain and swelling in the heel are typical symptoms. Retrocalcaneal Bursitis Affects the bursa behind the Achilles' tendon. It occurred during my training for my first 50 mile race. The retrocalcaneal bursa is a slippery sac that is filled with fluid that cushions and lubricates the area amidst the heel bone and the Achilles tendon. shoes becoming uncomfortable; What causes it? Bursitis relates to inflammation of a bursa in the retrocalcaneal region. This can be debilitating, causing pain, swelling, and limited movement. Bursitis is the inflammation of a bursa. 2022 The American Medical Society for Sports Medicine. It causes severe pain and swelling. Due to the location of the bursa, retrocalcaneal bursitis may be misdiagnosed as Achilles tendonitis. What Is Retrocalcaneal Bursitis? [2] Inflammation of either or both of these bursa can cause pain at the posterior heel and ankle region. The pain typically increases with walking and running. The synthetic cortisone is combined with a local anesthetic and injected in or around a specific area of the body such as the bursa region. Become a PhysioAdvisor Member and gain full access to our complete Injury Database. Retrocalcaneal Bursitis David I. Pedowitz A 35-year-old male recreational runner complains of dull, aching heel and posterior ankle pain that is aggravated by activity and shoe wear. Rarely, severe cases may require you to have a bursectomy (surgery to remove the bursa). If you have a bony enlargement on the back of the heel that rubs the Achilles tendon, it can cause the formation of a bursa (small fluid filled sack). 2006 Feb. 2(1):27-9. This is often referred to as bursitis. Your body has many of them. In most instances, it is best to work with a physical therapist. Early mornings and late evening appointments available. It can be caused by disease, injury, or wearing shoes that have rigid back support that strains the lower portion of the Achilles tendon. Members Only ContentBecome a PhysioAdvisor Member to gain full access to this exclusive content. If the area is touched, it may be painful. Retrocalcaneal bursitis is a condition that causes heel pain. Also called retrocalcaneal bursitis or Albert's disease, this type of bursitis causes inflammation in the bursa where the Achilles tendon attaches to the heel. 81(3):387-90. Van Sterkenburg MN, Muller B, Maas M, Sierevelt IN, van Dijk CN. Heel bursitis, also known as retrocalcaneal bursitis, is a type of bursitis (a condition where small fluid filled sacs that act as a cushion around joints become inflamed and swollen) that causes pain above the heal on the foot. Retroachilles bursitis almost always caused by poorly fitting shoes that rub or dig into the back of your heel. The bursa may also be primarily involved by inflammatory or infectious bursitis 4. The inflammation may be caused by shoe irritation, a tight Achilles tendon, Achilles tendonitis, or a bony growth in the back of the heel known as a Haglund's deformity. Retrocalcaneal bursitis is a common cause of heel pain due to inflammation of the bursa at the back of the heel. Showing item 1 - 12 of 719 Dr Comfort Sean - Mens Athletic Shoe: $184.95. The retrocalcaneal bursa is a fluid filled sac that occupies the space between the heel (calcaneus) bone and the Achilles tendon. You also get the joy of seeing our amazing sales, From November 25th through November 28th, you can take advantage of some fantastic deals at Chiappetta Shoes Black Friday Sale. Yes, there are different types of cortisone. They are found in areas where rubbing may occur, such as between tendons and bones. The feet are full of flexible structures consisting of bones, muscles, joints and soft tissues that allow you to stand upright and perform activities such as running, walking and jumping. Follow these guidelines to restore range of motion and ultimately return to play: Daily calf stretches: each of the two calf muscles should be stretched separately, and held for thirty seconds and repeated. 600 Grant St Ste 208Denver, CO 80203(303) 832-5577Fax (303) 996-0390, Hours:Monday Thursday: 7:30am 7pmFriday: 8am 12pmSaturday & Sunday: Closed, 7821 W 38th Ave #101Wheat Ridge, CO 80033(303) 955-8091, GET STARTED The following outlines other symptoms of retrocalcaneal bursitis: Retrocalcaneal bursitis is typically caused by overuse of the heel and ankle. Retrocalcaneal Bursitis is primarily caused by repetitive or sudden overuse of the Achilles Tendon through activities such as walking uphill, running or jumping. . Some of your favorite brands like Clarks, Cobb Hill, Salvia, New Balance, Rieker, Dansko, Wanderlust, and Spring Step will be, It's that time to start thinking about what to get for him or her. Retrocalcaneal bursitis, also called Achilles tendon bursitis, occurs when the bursa becomes irritated, causing pain in the foot and heel. Achilles Bursitis (Retrocalcaneal Bursitis). Retrocalcaneal bursitis can result from sports activities and the frequent use of poor-fitting and high-heeled shoes. These include the following: A bursitis foot cortisone injection is a specially-designed treatment measure that provides short-term pain relief by reducing inflammation of the soft tissues of the foot; specifically, the bursa. A bursa is a thin fluid filled sac found in various places throughout the body. II, 2022 Black Friday Sale | Up to 50% Off | Chiappetta Shoes, Chiappetta Shoes His and Hers Holiday Gift Guide 2022. Activities that repetitively overflex the foot upward, such as hill running, cause the Achilles tendon to press against the bursa and can also cause inflammation. A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis. What are the Symptoms of Bursitis? We even have early morning and late night appointments. Wear ill-fitting shoes; Any minor trauma and repetitive movements that involve the bursae can lead to bursitis, as can infections that spread from other areas of your body. Well explain how we can help with your pain. We go. Generally speaking, it is advised to engage in stretching of the heal. It is possible for bursitis to develop in both bursae at the same time, making the pain and inflammation more difficult to treat. Etiology. The calcaneal bursa is located in between the Achilles tendon and the skin at the back of the heel. tight/poorly fitting running shoes, lack of stretching, fat pad atrophy, and Achilles . Print our New Client Welcome Packet, Service Area & Drive TimesLakewood 10 minEdgewater 13 minBerkley 14 minLakeside 15 minEnglewood 15 minWheat Ridge 17 minWestminster 19 minThornton 19 minArvada 19 minAurora 24 min. The pain may be mild; however, it could range from moderate to severe pain. Retrocalcaneal bursitis is the most common type of heel bursitis. It can be caused by certain activities, arthritis, and abnormality of the foot such as the development of haglund's deformity. Retrocalcaneal bursitis is an inflammation of a bursa between the Achilles tendon and heel bone. Heel Lifts (Elevators Talar Made) (Pack of 5 Pairs), Forearm Crutches Adjustable Standard Grip, Hamstring Origin Tendonitis (Tendinopathy), inappropriate footwear (e.g. Injections For Retrocalcaneal Bursitis Operative Treatment Options Potential Complications Post Operative Period & Recovery FAQs Symptom Checker Where is your pain? This aids in optimizing the flexibility of the area and helps to alleviate any and all impingements on the bursa, which naturally relieves symptoms of the condition. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region. I've had retrocalcaneal bursitis since Oct 2020. Bursitis is a treatable condition. and cut a 1 1/2 inch high x 3/4 inch wide notch out of the pair of shoes I resumed running in. 1-866-324-3338; Sign In; my account; . Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 3). Our innovative care strategies at Tennessee Sports Medicine will help you find quick relief. This condition is very often linked to . Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 4). For more details see Become a Member. Ultrasound-guided injection treatment of retrocalcaneal bursitis. This condition is a bony enlargement on the back of the heel that can aggravate the retrocalcaneal bursa, a fluid-filled sac located on the back of the heel between the Achilles tendon and the calcaneus. The retrocalcaneal bursa is a fluid-filled or cushioning sac between the Achilles tendon and heel bone. 2006 Sep. 25(5):734-6. Heel bursitis symptoms tend to be worse when running uphill or when standing on tiptoes. 2010 Jun. AMSSM Member AuthorsAlexander Kim, MD and Crystal Hnatko, DO. Bursae are designed to reduce friction between adjacent layers of tissue and are filled with lubricating fluid. Repeat 10 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms. . Other risk factors for retrocalcaneal bursitis include poorly fitted shoes, tightness in the calf muscles and certain medical conditions including gout, rheumatoid arthritis and fibromyalgia. When these bursae fluid-filled sacs present around the joints become inflamed, the resulting condition is. Physical Therapy, elevating the feet, resting the feet, icing the area, over-the-counter medications for inflammation, and wearing a shoe that is designed with an elevated heel are all effective treatments for retrocalcaneal bursitis. Living with retrocalcaneal bursitis. Repeat 10 20 times provided there is no increase in symptoms. You should consult with a doctor when you want to start new exercises. Symptoms of Retrocalcaneal Bursitis Deep achy pain in the back of ankle Visible swelling Pain when foot moves into dorsiflexion (ankle and toes move up towards nose) Pain when squeeze just above and in front of achilles Stiffness Red and/or warm skin around back of ankle Shoes become very uncomfortable, normally prefer open back shoes Chiappetta Shoes has such an incredible amount of holiday inventory that we had to make another gift guide to cover our fantastic merchandise. In considering retrocalcaneal vs. subcalcaneal bursitis, the pathology is essentially the same but the location is different. Luckily, Chiappetta Shoes has curated a footwear gift guide with a wide range of prices to give a gift that is guaranteed to be loved! To prevent this injury from recurring, calf stretching and strengthening exercises should be continued after symptoms have resolved. The bursae near the heel are located behind the Achilles tendon, above its attachment to the heel bone. Achilles Bursitis September 28, 2022 Achilles bursitis is also known as Retrocalcaneal bursitis. The most common cause of retrocalcaneal bursitis is overusing the heel and ankle area. Wiegerinck JI, Kok AC, van Dijk CN. Try using over-the-counter or custom heel wedges in your shoe to help decrease stress on the heel. Acta Orthop. Retrocalcaneal Bursitis - Taping Technique 62,076 views Nov 28, 2017 472 Dislike Share NAT Education 74.4K subscribers Worn or incorrectly sized footwear or excessive pronation of the foot can. This is due to the fact that physical therapy helps in strengthening the heel and the ankle, which can aid in optimizing mobility. The following outlines the best retrocalcaneal bursitis treatment exercises: There are many treatments available for retrocalcaneal bursitis. Went straight into 50mpw . Once the heel starts healing, low-impact physical activities may be pursued. Wearing a temporary cast, brace or boot. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Symptoms of Retrocalcaneal Bursitis Swelling and severe pain are the main symptoms of heel bursitis. The bursa can become inflamed and swollen, a condition called bursitis. Tags: bursitis of the foot and ankle Retrocalcaneal bursitis. Immediately after resting and icing, you should attempt to resume low-impact physical activities. There are many pairs of Crocs and if your job allows, these can take care of most of the symptoms associated with Haglunds deformities. Mutlu H, Sildiroglu H, Pekkafali Z, Kizilkaya E, Cermik H. MRI appearance of retrocalcaneal bursitis and rheumatoid nodule in a patient with rheumatoid arthritis. At first, you should work under the immediate supervision of a physical therapist. This can be called 3 things: Retrocalcaneal bursitis, heel bursitis or insertional achilles tendonitis! It is so close to the Achilles tendon that retrocalcaneal bursitis is often mistakenly diagnosed by medical professionals as Achilles tendonitis. It is where the large Achilles tendon connects the calf muscles to the heel bone. The retrocalcaneal bursa is located in the back of the ankle by the heel. Haglunds syndrome: diagnosis and treatment using sonography. This inflammation can occur by friction or shearing of the bursa, which can be caused by shoes that squeeze your heel or cause you to change your gait. 2008 Jun. Sometimes it can be tough to find a gift anyone would like, but shoes are an, Chiappetta Shoes | 6821 39th Ave | Kenosha, WI 53142, Holiday Accessory Guide @ Chiappetta Shoes 2022 Pt. Continuing these measures, along with wearing well-fitting shoes can reduce the risk of recurrence of retrocalcaneal bursitis. Extra bone formation (exostosis) on the back (reho) of the heel bone (calcaneous) is called a retrocalcaneal exostosis. The calf comprises of 2 major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon. Retrocalcaneal Bursitis is what the doc ordered! Surg Radiol Anat. Wedge orthotics may help with calf tightness by providing heel support. Then as the foot adjusts, the correction is increased. Retrocalcaneal bursitis is the inflammation of a bursa between heel bone and Achilles tendon. . If you wear high heels, you might need to switch to a medium height shoe for a while. Non-steroidal anti-inflammatory medications such as ibuprofen and naproxen may help with pain and inflammation. Some of the most commonly recommended products by physiotherapist for patients with retrocalcaneal bursitis include: To purchase physiotherapy products for retrocalcaneal bursitis click on one of the above links or visit the PhysioAdvisor Shop. It can be a debilitating problem, making it difficult for you to walk and go about your day-to-day activities. Retrocalcaneal bursitis is the most common type of heel bursitis. Our experienced physiotherapists are updating PhysioAdvisors injury articles to include the most important information to help users take control of their injury and hasten their recovery. 49(3 Suppl):S1-19. When this occurs the treating physiotherapist or doctor can advise on the best course of management. The back of the heel may become warm, red, and swollen. When this bone becomes enlarged, inflammation of the retrocalcaneal bursa occurs. Check Now Make an appointment Foot and Ankle Conditions Adult Conditions Symptom Checker 2nd MTP Joint Instability 5th Metatarsal Base Fracture Accessory Navicular Our combined Podiatry Clinic and Sports Shoe Store located in Brisbane has everything you need to get you back on your feet, whether you are a walker, runner, super active kid or a fitness fanatic. Retrocalcaneal bursitis is a condition characterized by tissue damage and inflammation of the retrocalcaneal bursa (a small fluid filled sac located at the back of the heel) causing pain in the heel region. I have two pairs of dress shoes that I used: 1) Cole Haan Air Colton Wingtip oxford (the ones I wear the most and believed caused the problem), and 2 . At Chiappetta Shoes , we pride ourselves in the combination of science and art and offer every day, common sense solutions, every day. Symptoms can vary depending on the source of the bursitis. The main symptom of retrocalcaneal bursitis is pain in the back of your heel. Cortisone is an anti-inflammatory-based medication that is utilized to treat a wide array of musculoskeletal conditions. It is commonly called "heel bursitis ." 4. When starting an exercise regimen for retrocalcaneal bursitis, it is imperative to remember that a warm-up should always be performed. Symptoms include heel pain and tenderness, and evaluation should be performed by a physician for diagnosis. If you are in Denver and need a Physical Therapist, call us! 2012 Feb. 28(2):283-93. Advert Symptoms Symptoms of Achilles bursitis usually develop gradually over time and include: If you want to stay active during this time, try an alternative, low-impact activity, such as swimming. They are typically located in regions of the body where tissue layers may rub against each other or against bony prominences (figure 1). 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