Retrocalcaneal (Heel) Bursitis

Retrocalcaneal (heel) bursitis occurs when the bursa situated between the Achilles tendon and the heel bone (calcaneus) becomes inflamed. This bursa plays a crucial role in minimizing friction; this facilitates smooth movement of the Achilles tendon as the ankle moves.

Symptoms

Retrocalcaneal bursitis usually presents with the following symptoms:

• Pain and swelling around or near the heel
• Tenderness in the affected area
• Worsened pain when standing on toes
• A warm feeling around the heel
• Skin discoloration near the heel

Causes

Retrocalcaneal bursitis can develop due to various factors, including:

• Overuse or repetitive stress from activities like running or jumping
• Improper footwear that presses or rubs on the back of the heel
• Abnormal foot biomechanics, such as flat feet, tight calf muscles or high arches
• Trauma or direct injury to the back of the heel
• Underlying medical conditions, including gout, rheumatoid arthritis or Haglund’s deformity

Diagnosis

Our healthcare providers at The Joint Pain Clinic usually diagnose heel bursitis through:

• Physical examination: Checking for tenderness, swelling and pain around the heel.
• Medical history: Reviewing symptoms, activity levels and potential causes.
• X-rays: These offer a clear view of the heel bone, helping to identify any irregularities that could be contributing to the issue.
• Magnetic resonance imaging (MRI): This can assist in determining whether the heel pain is caused by another condition besides bursitis, like Achilles tendinitis.

Treatment and Management

The treatment plan for heel bursitis varies based on the cause and often includes:

• Orthotics: Heel wedges or custom orthotics to improve walking mechanics and alleviate pressure on the heel.
• Physical therapy: The treatment plan for heel bursitis includes physical therapy, which focuses on stretching the Achilles tendon and strengthening the ankle, calf and foot muscles.
• Corticosteroids: Injections to reduce inflammation and pain in the affected area.
• Surgery: In rare cases, if pain continues for six to twelve months, surgical removal of the affected bursa may be necessary.
• Antibiotics: Oral antibiotics may be prescribed if an infection is present.