Retrocalcaneal bursitis is the inflammation of the retrocalcaneal bursa, which is located behind the heel bone, also known as the calcaneal bone (hence the name retrocalcaneal). The retrocalcaneal bursa is a thin, slippery, fluid-filled sac that serves as a both a cushion and lubricant between the heel bone and the Achilles tendon. Inflammation of the retrocalcaneal bursa usually results from irritation of the bursa. This irritation may be due to certain activities, an underlying health condition such as arthritis, or an abnormality of the foot, such the development of a boney prominence on the calcaneal bone, called a Haglund's deformity.
Retrocalcaneal bursitis can be caused through injury or infection or be can be triggered by certain health conditions. If bursitis develops as a result of injury then it will normally be due to a repetitive strenuous activity that encourages the calf muscles (the gastrocnemius and soleus muscle), which attach to the heel bone via the Achilles tendon, to tighten and shorten from overuse, for example repetitively wearing high heels, running and even wearing tight shoes that pinch at the back of the heel. This puts more pressure over the bursa as the tendon rubs more tightly over it, irritating it and triggering a painful inflammatory reaction (swelling). This risk of developing bursitis in this way is greater for those whose jobs or hobbies involve a lot of repetitive movements, for example carpet fitters and gardeners who spend a lot of time kneeling and so are more at risk of bursitis in the knee. Runners have a greater likelihood of developing bursitis in the hip. Bursitis can also be brought on by excessive pressure or direct impact trauma, such as banging your elbow or dropping on to your knees. Infection is a less common cause of bursitis and normally only occurs in people who have a weakened immune system from other health issues. The infection can work its way to the bursa from a cut close to the bursa that has become infected, in these cases the bursitis is termed as septic bursitis. Certain health conditions can also trigger the development of bursitis, such as rheumatoid arthritis and gout, amongst others.
The main symptom of heel bursitis is pain. You may experience pain in your heel when you walk or run. There may also be pain if the area is touched or if you stand on your tiptoes. In addition to pain, the area may appear red and warm, which are both signs of inflammation. Even if you have these symptoms, only a doctor can determine if you have bursitis of the heel. Your doctor will use these symptoms along with a general exam to determine if you are suffering from bursitis of the heel.
The diagnosis is based on the symptoms and an examination. For anterior Achilles tendon bursitis, doctors use x-rays to rule out a fracture of the heel bone or damage to the heel bone caused by rheumatoid arthritis or other inflammatory arthritis.
Non Surgical Treatment
The patient with retrocalcaneal bursitis should be instructed to apply ice to the posterior heel and ankle in the acute period of the bursitis. Icing can be performed several times a day, for 15-20 minutes each. Some clinicians also advocate the use of contrast baths. Gradual progressive stretching of the Achilles tendon may help relieve impingement on the subtendinous bursa and can be performed in the following manner. Stand in front of a wall, with the affected foot flat on the floor. Lean forward toward the wall until a gentle stretching is felt within the ipsilateral Achilles tendon. Maintain the stretch for 20-60 seconds and then relax. Perform the stretches with the knee extended and then again with the knee flexed. To maximize the benefit of the stretching program, repeat the above steps for several stretches per set, several times daily. Avoid ballistic (ie, abrupt, jerking) stretches. Other treatment options are microcurrent therapy and corticosteriod injection into the retrocalcaneal bursa. If conservation treatment fails then surgery is indicated.
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.