Retrocalcaneal Bursitis

By Justin Carmel, PT, DPT

What is Retrocalcaneal Bursitis?

Retrocalcaneal bursitis is inflammation of the bursa (a small, cushioning sac located where tendons pass over areas of bone around the joints), which lies over your heel (calcaneum) where your Achilles tendon inserts. Retrocalcaneal bursitis also happens to be the most common form of heel bursitis.

Bursitis is a treatable condition. JOI offers many options for this injury.

Image of Bursitis written on a board.

What are Retrocalcaneal Bursitis Symptoms?

One or more of the following symptoms may be experienced:

  • Pain and swelling occurring over the rear your heel.
  • Pain when you are leaning on your heel eg sitting with heels on the ground.
  • Increased pain when using your calf muscles.eg running, walking, and calf raises.

What Causes Retrocalcaneal Bursitis?

The retrocalcaneal bursa may be inflamed by your Achilles tendon rubbing over the bursa and causing friction against the heel bone. This injury can occur traumatically from a fall or a sport-related impact contusion.

It can also be a case of gradual onset via repetitive trauma to the bursa from activities as running and jumping, or excessive loading on your heel. Athletes who wear tight-fitting shoes while practicing or exercising are more prone to the condition. So too are those who don’t stretch or warm up properly before such activities. Some cases may result from an infection or a disease such as arthritis.

Retrocalcaneal bursitis can also be a secondary injury associated with chronic conditions such as:

How is Retrocalcaneal Bursitis Diagnosed?

Your physical therapist or doctor will provide you with an assessment of your medical history and a physical examination of your heel and ankle.  A hallmark sign of retrocalcaneal bursitis is swelling or tenderness of your heel around the insertion of your achilles tendon.  Diagnosis can also be confirmed by medical imaging techniques that include ultrasound scan & MRI.

Treatment for Retrocalcaneal Bursitis

The aim of treatment is to ease symptoms so that the bursa has time to heal. Treatment may include:

  • You may need to alter or limit activities that cause heel pain. These include high-impact activities like running.
  • Prescription or over-the-counter medicines. These help reduce pain and swelling.
  • Cold packs or heat packs. These may ease pain.
  • Shoe inserts or padding. Devices such as heel cups or pads for the back of your heel can ease discomfort when moving.
  • You should avoid wearing tight-fitting shoes or those that rub the back of your heel. Shoes with an open-back heel, such as clogs, may help.
  • Stretching exercises. Gentle stretching movements can restore flexibility in your ankle and foot. They can also help with pain.
  • Steroid injection. A needle is used to inject a pain reliever and steroid into the affected bursa. This shot can relieve pain and reduce swelling for several weeks.
  • This treatment is rarely needed unless other options don’t work.

Complications 

  • Limited range of motion in the affected foot and ankle.
  • Infected bursa.

Is Retrocalcaneal Bursitis Preventable?

There are a few easy steps you can take to avoid getting retrocalcaneal bursitis:

  • Stretch and warm-up before working out.
  • Use good form when exercising.
  • Wear supportive shoes.

Author: Justin Carmel 

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