Heel bursitis is a common foot pain in athletes, and is often mistaken for Achilles tendinitis, although it can also occur together with Achilles tendinitis. Heel bursitis occurs when small cushions in the heel called bursas become inflamed and swell with fluid irritating surrounding tissue and pressing on nerves. Other names given to heel bursitis are Achilles bursitis and Retrocalcaneal bursitis.
The calcaneal bursa can become inflamed in patients with heel spurs or in patients with poor-fitting shoes (eg, high heels). Inflammation can occur secondarily from Achilles tendinitis, especially in young athletes. Patients exhibit tenderness to palpation of the bursa anterior to the Achilles tendon on both the medial and lateral aspects. They have pain with movement, which is worsened with dorsiflexion.
In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal bursa. Other symptoms may include redness and swelling at the back of the heel.
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
Many cases of retrocalcaneal bursitis can be resolved with self-care that is focused on reducing inflammation and eliminating activities or positions that aggravate the bursa. Some cases, however, may become more serious and require more medical interventions. Rarely, surgery is needed. Following the R.I.C.E. formula, or Rest, Ice, Compression, and Elevation, is often sufficient to treat aseptic bursitis. Rest. People with retrocalcaneal bursitis should avoid activities that irritate the bursa, such as jogging or excessive walking. Ice. Applying a cold compress to the back of the ankle for about 20 minutes two or three times a day may help alleviate symptoms and decrease swelling. Compression. An elastic medical bandage (e.g. Ace? bandage) wrapped around the affected heel and ankle can help control swelling. Elevating the affected heel. Sitting down with the leg elevated on a stool or lying down with the foot elevated on a pillow can help reduce blood flow to the area, thereby reducing inflammation.
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.