Heel bursitis is also known as retrocalcaneal bursitis. The heel bone is called calcaneus, and the bursa associated with the heel bone is located in the area between the Achilles tendon and calf
muscles. When this particular bursa gets aggravated due to constant pressure in the ankle, the posterior end of the heel or the area behind the heel gets inflamed and hence the result is
retrocalcaneal bursitis. Strain to the ankles could be caused due to various reasons like extraneous jogging, skipping, or such physical activities that increase the pressure on the ankles.
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.
Pain and tenderness usually develop slowly over time. Applying pressure to the back of the heel can cause pain. Wearing shoes may become uncomfortable. The back of the heel may feel achy. Pain is
exacerbated when the foot is pointed or flexed, because the swollen bursa can get squeezed. A person with retrocalcaneal bursitis may feel pain when standing on their toes. Fever or chills in
addition to other bursitis symptoms can be a sign of septic bursitis. Though uncommon, septic retrocalcaneal bursitis is a serious condition, and patients should seek medical care to ensure the
infection does not spread.
Plain radiographs of the calcaneus may reveal a Haglund deformity (increased prominence of the posterosuperior aspect of the calcaneus). However, on weight-bearing lateral radiographs, the
retrocalcaneal recess often appears normal even in patients with retrocalcaneal bursitis, limiting its usefulness in making this diagnosis.Radiographs may be used as a diagnostic measure to support a
clinician?s diagnosis of retrocalcaneal bursitis. Individuals with retrocalcaneal bursitis may have an absence of the normal radiolucency (ie, blunting) that is seen in the posteroinferior corner of
the Kager fat pad, known as the retrocalcaneal recess or bursal wedge. This may occur with or without an associated erosion of the calcaneus.
Non Surgical Treatment
With posterior Achilles tendon bursitis, treatment is aimed at reducing the inflammation and adjusting the foot's position in the shoe to relieve pressure and motion on the back of the heel. Foam
rubber or felt heel pads can be placed in the shoe to eliminate pressure by elevating the heel. Placing protective gel padding over the painful bursa or stretching the back part of the shoe and
placing padding around the inflamed bursa may help. Sometimes a special shoe, such as a running shoe designed to stabilize the midsole heel, devices placed in the shoe (orthoses), or both can help to
control abnormal foot and heel motion contributing to the posterior heel irritation. Other shoes have padding that reduces irritation to the posterior heel and Achilles tendon.
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, good flexibility, and strength around the ankle to help prevent this condition from arising. Proper stretching of the achilles tendon helps prevent injury.