Whenever tissues rub against one another, a bursa forms to allow for smooth gliding. A bursa is a fluid-filled sac and occurs normally throughout the body. Only a few cell layers thick, a bursa is
filled with a lubricating fluid. However, when irritated, a bursa can become markedly thickened and painful. This is often referred to as bursitis. The retrocalcaneal bursa is positioned to allow the
Achilles tendon to glide over the back part (posterior aspect) of the heel bone. When this bone becomes enlarged, inflammation of the retrocalcaneal bursa occurs. This inflammation results in
exquisite tenderness along the posterior aspect of the heel.
The causes and risk factors of retrocalcaneal bursitis are listed below. Identifying the underlying reason the bursa is inflamed will help set a course for treatment. Repetitive use of the ankle.
Retrocalcaneal bursitis is often caused by frequent "mini-traumas." These mini-traumas are often due to excessive walking, jumping, or running. Running uphill, which causes the foot to flex
considerably, can be especially irritating to the retrocalcaneal bursae. People who suddenly intensify their exercise programs without adequate stretching and muscle conditioning may get
retrocalcaneal bursitis. In general, it is often associated with over use of the Achilles attachment, the area where the Achilles tendon fibers attach to the heel.
When the bursa becomes inflamed after an injury, symptoms usually develop suddenly. When the bursa develops without an injury, symptoms may develop gradually. With both posterior and anterior
Achilles tendon bursitis, symptoms usually include swelling and warmth at the back of the heel. A minimally red, swollen, tender spot develops on the back of the heel. When the inflamed bursa
enlarges, it appears as a red lump under the skin of the heel and causes pain at and above the heel. If posterior Achilles tendon bursitis becomes chronic, the swelling may become hard, fluid-filled,
and red or flesh-colored.
Bursitis is usually diagnosed after a careful physical examination and a full review of your medical history. If you garden and spend a lot of time on your knees, or if you have rheumatoid arthritis,
tell your doctor, this information can be very helpful. During the physical exam, he or she will press on different spots around the joint that hurts. The goal is to locate the specific bursa that is
causing the problem. The doctor will also test your range of motion in the affected joint. Other tests usually aren?t required to diagnose bursitis, but your doctor may suggest an MRI, X-ray or
ultrasound to rule out other potential causes of pain.
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.
Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition. Proper stretching of the Achilles tendon helps prevent injury.