Retrocalcaneal bursitis is a painful inflammation of the soft tissues at the attachment of the Achilles tendon to the back of the heel bone. The retrocalcaneus identifies the ?retro? or behind and
?calcaneus? or heel bone. Bursitis relates to inflammation of a bursa in the retrocalcaneal region. A bursa anatomically is a fluid filled sack that is located around tendinous attachments in the
body. The retrocalcaneal bursa as identified in the photo 1 protects the Achilles tendon just prior to its insertion to the retrocalcaneal region. The retrocalcaneal bursa cushions the Achilles
tendon and normally allows pain free motion of the Achilles tendon over the calcaneus.
Feet are extremely resilient and are designed to stand up to the pressures of day-to-day living. In some cases, though, foot structures may break down when subjected to chronic stress associated with
long periods of weight-bearing activity on concrete, asphalt, or other hard surfaces (especially when footwear does not allow for proper weight distribution). Foot problems, including infracalcaneal
bursitis, are often made worse by poorly designed footwear, and pressure, impact, and shear forces can damage the feet over time. Bursal sacs are intended to minimize this damage, but sometimes the
bursa itself becomes inflamed. A rapid increase in physical activity levels or thinning of the heel?s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible
causes of infracalcaneal bursitis include blunt force trauma. Arthritic conditions. Acute or chronic infection. The following factors may increase a person?s risk of bursitis, including
infracalcaneal bursitis. Poor conditioning. Exposure to cold weather. Participating in contact sports. Having a previous history of bursitis in any joint. Heel striking when running, especially in
conventional running shoes with heel elevation.
Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping.
Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of
the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).
Medical examination is not necessarily required in light cases where the tenderness is minimal. In all cases where smooth improvement is not experienced, medical attention should be sought as soon as
possible to exclude a (partial) rupture of the Achilles tendon or rupture of the soleus muscle. This situation is best determined by use of ultrasound scanning, as a number of injuries requiring
treatment can easily be overlooked during a clinical examination (Ultrasonic image). Ultrasound scanning enables an evaluation of the extent of the change in the tendon, inflammation of the tendon
(tendinitis), development of cicatricial tissue (tendinosis), calcification, inflammation of the tissue surrounding the tendon (peritendinitis), inflammation of the bursa (bursitis), as well as
Non Surgical Treatment
There are a variety of treatments for bursitis of the heel. Bursitis on the bottom of your heel (which is called infracalcaneal bursitis) is common in heels with thinning fat pads. Gel heel cushions
or custom made orthotics (that have a horse-shoe cut and extra foam in the heel) can be lifesavers in reducing the pain. For bursitis of the posterior heel (retrocalcaneal bursitis), try to avoid
going barefoot and to reduce the stress on the Achilles tendon by not over flexing your heel, the tighter your Achilles becomes, the more you compress the bursa sacs of the posterior heel. Heel lifts
can help this, or wearing shoes with elevated heels (note that this method is not sanctioning high heels, as high heels can provide little comfort or support and usually are tight in the areas where
your bursitis is most inflamed). Products such as AirHeel made by Aircast can help massage the bottom and back of the heel, helping to decrease pain.
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.
Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition. Proper stretching of the Achilles tendon helps prevent injury.