Heel bursitis is specifically the inflammation of the retrocalcaneal bursa, located at the back of the heel, under the Achilles tendon. There are a handful of factors that put you at risk for
developing heel bursitis. Long distance runners are prone to heel bursitis, due to repeated stress and pounding upon the heel joint. Engaging in activities such as running, bicycling, walking,
jumping, and stair climbing for extended periods of time can overwork the heel joints and start to irritate the bursae. Suddenly changing to a high-intensity workout regime puts a lot of stress on
the heel, making it vulnerable to injury. Hard blows/bumps to the heel can immediately damage the bursae, leading to swelling and inflammation. Training at high intensities without stretching and
warming up can also contribute to the development of heel bursitis. Even improper footwear can be a big factor. Some other conditions can put you at risk as well, such as: tarsal tunnel syndrome,
rheumatoid arthritis, plantar fasciitis, muscle weakness, joint stiffness, and heel spurs. It is very important to get a professional diagnosis if you are having heel pain because heel bursitis is
often confused for Achilles tendonitis, and the proper treatments are very different. The pain could also be plantar fasciitis or general heel pain syndrome.
Occasionally the bursal sac can become inflamed and painful. Pain to the region is worse typically with initial weight bearing activity such as rising from bed in the morning. Swelling and warmth to
the region are common. Clinical examination shows pain to palpation at the retrocalcaneus at a level just before the Achilles tendon. Increase pressure and friction of the Achilles tendon across the
retrocalcaneal region is the cause of this bursitis. A high arch, tight Achilles tendon or bone spur appear to be some of the main causes of this problem. With a high arch the back portion of the
calcaneus abnormally projects into the Achilles tendon region.
When the bursa becomes inflamed after an injury, symptoms usually develop suddenly. When the bursa develops without an injury, symptoms may develop gradually. With both posterior and anterior
Achilles tendon bursitis, symptoms usually include swelling and warmth at the back of the heel. A minimally red, swollen, tender spot develops on the back of the heel. When the inflamed bursa
enlarges, it appears as a red lump under the skin of the heel and causes pain at and above the heel. If posterior Achilles tendon bursitis becomes chronic, the swelling may become hard, fluid-filled,
and red or flesh-colored.
Your doctor will take a history to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will
look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the achilles tendon over the inflamed bursa.
Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the achilles tendon to the heel bone. Imaging studies such as X-ray and MRI are not usually necessary at
first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.
Non Surgical Treatment
Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence in all patients with retrocalcaneal bursitis. Treatment may
comprise soft tissue massage (particularly to the calf muscles), joint mobilization (of the ankle, subtalar joint and foot), dry needling, electrotherapy (e.g. ultrasound), stretches, the use of heel
wedges, the use of crutches, ice or heat treatment, arch support taping, the use of a compression bandage, exercises to improve strength, flexibility, balance and core stability, education,
anti-inflammatory advice, activity modification advice, biomechanical correction (e.g. the use of orthotics), footwear advice, a gradual return to activity program.
Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a
pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle
or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be
underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).