Retrocalcaneal bursitis is an inflammation or infection of the bursae at the back of the heel bone. Bursae are fluid-filled sacs that cushion the joints and prevent the bones from becoming injured
due to friction. Because this condition can cause pain and difficulty moving, getting treatment is important. There are several retrocalcaneal bursitis treatment options available. Patients and
physicians should work together to determine the best treatment based on the symptoms and severity of the condition.
Inflammation of the calcaneal bursae is most commonly caused by repetitive overuse and cumulative trauma, as seen in runners wearing tight-fitting shoes. Such bursitis may also be associated with
conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies. In some cases, subtendinous calcaneal bursitis is caused by bursal impingement between the Achilles tendon and
an excessively prominent posterior superior aspect of a calcaneus that has been affected by Haglund deformity. With Haglund disease, impingement occurs during ankle dorsiflexion.
Symptoms include pain at the back of the heel, especially when running uphill or on soft surfaces. There will be tenderness and swelling at the back of the heel which may make it difficult to wear
certain shoes. When pressing in with the fingers both sides are the back of the heel a spongy resistance may be felt.
Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis, a fracture or tumor. A doctor also will try to determine if the Achilles
tendon itself is a source of pain. To make a diagnosis, a doctor will use some or all of the diagnostic tools below Patient interview. A doctor will ask a patient about medical history, and to
describe the onset of his or her symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask patients what types of shoes they wear and what they do
for exercise. A patient's reported symptoms are important to diagnosis and treatment. The doctor will also ask what home treatments have helped the condition. Physical exam. A doctor will examine the
patient's foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.
Non Surgical Treatment
In addition to R.I.C.E., there are a number of other treatments to reduce swelling and any associated pain or discomfort due to heel bursitis. Orthotics or change of footwear. Wearing an orthotic
device such as a heel insert can encourage better mechanics in the foot and reduce irritation of the retrocalcaneal bursa. Some people do not need special orthotics but simply need to stop wearing
shoes with rigid heel and ankle construction and instead wear more supportive, comfortable shoes. Shoes with an "Achilles notch," a groove in the collar at the back of the shoe to protect the
Achilles tendon, can be particularly helpful. (Almost all running shoes are designed with an Achilles notch.) Stretching and physical therapy. Stretching the Achilles tendon often helps alleviate
pain. Once the pain is resolved it is important for the patient to continue a regular stretching program. Regular stretching reduces the chance of recurrence.
You may be able to prevent bursitis from happening or coming back. Continue your home treatment with rest, ice, pain relievers, and gentle exercises. When you are ready to try the activity that
caused the pain, start slowly and do it for short periods or at a slower speed. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. Use ice afterward
to prevent pain and swelling. Change the way you do activities with repeated movements that may strain your muscles or joints. For example if using a certain tool has caused bursitis, start switching
hands or change the grip size of your tool. If sitting for long periods has caused bursitis, get up and walk around every hour. If a certain sport is causing bursitis, consider taking lessons to
learn proper techniques. Have an expert check your equipment to make sure it's well suited to your size, strength, and ability. If certain activities at work may be causing bursitis, talk to your
human resources department about other ways of doing your job, equipment changes, or other job assignments. Protect your joints from pressure. Cushion knees or elbows on hard surfaces, and wear shoes
that fit you well and have good support.