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. A bursa is a thin fluid filled sac found in various places throughout the body. Bursae are designed to reduce friction between adjacent layers of tissue and are filled with lubricating fluid.
They are typically located in regions of the body where tissue layers may rub against each other or against bony prominences The muscle group at the back of the lower leg is commonly called the calf.
The calf comprises of 2 major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon. Between the Achilles tendon and the heel bone lies a bursa known as
the retrocalcaneal bursa.
Bursitis, tendinitis, and other soft tissue rheumatic syndromes typically result from one or more factors. These include: Play or work activities that cause overuse or injury to the joint areas
Incorrect posture Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint) Other diseases or conditions (rheumatoid
arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction) Infection.
Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa.
Direct pressure on the bursa will exacerbate the pain and should be avoided if possible. Tenderness and swelling which might make it difficult to wear certain shoes on the feet. As the bursa becomes
more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a "pump bump", and is usually red, and extremely tender. Swelling can cause
difficulties moving as the range of motion in the ankle can be affected. Limping due to the pain may occur. If you press on both sides of the inflamed heel, there may be a firm spongy feeling.
Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads. Possibly a fever if you are suffering from septic bursitis (You
will need to see a doctor for medication to get rid of the infection). Pain at the back of the heel makes it difficult to continue wearing shoes, especially high heels with straps or shoes that don't
Obtaining a detailed history from the patient is important in diagnosing calcaneal bursitis. The following complaints (which the physician should ask about during the subjective examination) are
commonly reported by patients.
Other inquiries that the physician should make include the following. The clinician should ask about the patient's customary footwear (whether, for example, it includes high-heeled shoes or
tight-fitting athletic shoes). The patient should be asked specifically about any recent change in footwear, such as whether he/she is wearing new athletic shoes or whether the patient has made a
transition from flat shoes to high heels or vice versa. Individuals who have been accustomed to wearing high-heeled shoes on a long-term basis may find that switching to flat shoes causes increased
stretch and irritation of the Achilles tendon and the associated bursae. The specifics of a patient's activity level should be ascertained, including how far the patient runs and, in particular,
whether the individual is running with greater intensity than before or has increased the distance being run. The history of any known or suspected underlying rheumatologic conditions, such as gout,
rheumatoid arthritis, or seronegative spondyloarthropathies, should be obtained.
Non Surgical Treatment
Other than rest, once the diagnosis of heel bursitis (Achilles bursitis, Retrocalcaneal bursitis) has been confirmed then your treating doctor will either generally recommend one or more of the
following, Pain killers. Non steroid anti-inflammatory medication. A cortisone steroid injection. Surgery in extreme cases. Whilst the above may be beneficial for some people, others unfortunately
will not be suitable for such heel bursitis treatments. This may be for several reasons such as having already tried these medications with little to no benefit or not being able to take these type
of medications due to pre-existing medical conditions or alternatively some individuals may just prefer to avoid painful injections or strong medications and instead use a natural heel bursitis
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be
effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat
another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any
bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around
the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis
symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.