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.
For the most part, it is a genetic condition. You develop it by inheriting a foot type that is prone to the mechanical irritation that leads to the problem. If you have this particular foot type and
wear shoes that rub and irritate the back of the heel bone (calcaneus) where the Achilles tendon attaches, then you are even more likely to develop this type of bursitis. The contributing factors
include a supinated foot type, a heel bone with a prominence (or pointed shape that stick out toward the tendon) at the back, a tight Achilles tendon (referred to as Equinus by doctors), and a high
arch. All of these factors simply make it more likely that the back of the heel will press against the shoe and rub. As the tendon gets rubbed the wrong way, the bursa starts to develop and fill with
fluid. This response is really your body's way of protecting the tendon from damage, but it backfires. The friction from all that rubbing causes the bursa to become inflamed and swell. This causes
the bump to become red, hot and stick out even further. Much like a sore thumb, it then gets irritated by even the softest shoes.
Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or
Your doctor will examine you, including an evaluation of your gait, while you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk.
An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration,
muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your
health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment.
Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.
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.
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.
To prevent bursitis of the heel in the first place, always keep proper form during exercise. In addition, don?t jump into exercises that are too intense without building up to them. Strengthen and
flex your ankle.