• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Home
  • Online Consultation
  • About
  • Newsletter/Updates
  • Contact Us
  • Policies

Bone and Spine

Orthopedic health, conditions and treatment

  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors

Retrocalcaneal Bursitis – Causes and Treatment

By Dr Arun Pal Singh

In this article
    • Causes of Retrocalcaneal Bursitis
    • Presentation of Retrocalcaneal Bursitis
    • Differential Diagnoses
    • Lab Studies
    • Imaging
    • Treatment of Retrocalcaneal Bursitis
      • RICE
      • Medication
      • Physical Therapy
      • Footwear
      • Corticosteroid Injection
      • Prognosis of Retrocalcaneal Bursitis
      • Prevention
      • Related

Retrocalcaneal bursitis or insertional bursitis is a common cause of pain in the posterior heel or ankle due to inflammation of either retrocalcaneal bursa or subcutaneous calcaneal bursa.

Retrocalcaneal or subtendinous bursa is located between the Achilles tendon and the calcaneus. This bursa is anterior to Achilles tendon.

Subcutaneous calcaneal bursa is, superficial to the Achilles tendon. It is also called the Achilles bursa. This bursa is located between the skin and posterior aspect of the distal Achilles tendon.

Inflammation of either or both of these bursae can cause pain at the posterior heel and ankle region.

Causes of Retrocalcaneal Bursitis

Calcaneal bursae can get inflamed due to repetitive injury or overuse. It often occurs when athletes increase their running distance substantially.

Following factors are known to be associated with retrocalcaneal bursitis

  • Overtraining
  • Poorly fitting footwear [See Pump bump]
  • Haglund deformity
  • Subtalar joint misalignment
  • Systemic diseases
    • Gout
    • Rheumatoid arthritis
    • Seronegative spondyloarthropathies

Presentation of Retrocalcaneal Bursitis

The patient presents with symptoms of posterior heel pain, usually on one side but may affect both sides. Limp may be present.

Some patients present with a noticeable swelling [also called “pump bump because of association with the wearing of high-heeled shoes or pumps].

A recent change of footwear, any underlying condition like gout, rheumatoid arthritis and spondyloarthropathies should be enquired. The level of activity of the patient must be noted.

On examination, the posterior aspect of the heel may reveal swelling and redness. The region might be tender to palpation and warm to touch.

The clinical examination may distinguish if the inflammation is superficial [posterior] to Achilles tendon [ subcutaneous bursa] or deep [anterior ] to the Achilles tendon (subtendinous bursa).

Differential Diagnoses

  • Achilles Tendon Rupture
  • Achilles Tendinosis
  • Plantar Fasciitis
  • Tumors

Lab Studies

Lab tests Not required for diagnosis but may be done to find the systemic conditions that can cause retrocalcaneal bursitis if it cannot be explained by local factors [like poorly fitting shoes, increased running, high heels.]

The laboratory studies to be considered are to evaluate the possibility of gout (hyperuricemia), rheumatoid arthritis (blood count, ESR, C-reactive protein, rheumatoid factor, and HLA B-27.

Imaging

Plain radiographs of the calcaneus may reveal a Haglund deformity. [Bony enlargement on the back of calcaneum]

An absence of the normal radiolucency posteroinferior corner behind the calcaneum may suggest the condition.

X-rays can be used to rule out stress fractures of calcaneum because of a stress fracture. If there is a constant clinical suspicion in presence of normal x-rays, bone scanning or CT scanning may be considered.

mri-retrocalcaneal-bursitis
Image Credit: Journal of Clinical Imaging

MRI can show inflammation of bursa and can differentiate if the involved bursa is subcutaneous bursa or the subtendinous bursa. It is also able to tell the condition of the tendon. But MRI is generally not necessary in retrocalcaneal bursitis.

Treatment of Retrocalcaneal Bursitis

RICE

Treatment in the acute phase consists of rest, ice, compression and elevation [RICE Therapy]. Ice can be applied for about 20 minutes by use of ice packs several times a day. The affected part is rested in an elevated position and a compression bandage may be applied.

Medication

The patient can be given NSAIDs for pain relief and reduction of inflammation. Topical NSAIDs are able to deliver a large dose of anti-inflammatory medication to a focal painful area with minimal systemic distribution.

Physical Therapy

Stretch exercises for Achilles tendon are initiated once symptoms resolve.

[Read more on Stretch exercises for Achilles tendon]

The patient should decrease the activity level but can do swimming, water aerobics, and other aquatic exercises.

Footwear

A proper footwear can work wonders in patients of retrocalcaneal bursitis and the change made on an individual basis. The patient might be benefited from the use of open backed shoe because it relieves pressure from the heel region.

If a patient has developed symptoms due to shifting to flat shoes from high heeled shoes, the patient may be provided with a heel height to relax Achilles tendon.

Corticosteroid Injection

Corticosteroid injection into the retrocalcaneal bursa can be considered but an inadvertent injection into Achilles tendon may increase the risk of Achilles tendon rupture. Therefore utmost care should be taken and injection preferably applied under imaging.

Immobilization

Immobilization in a brace or cast for 4-6 weeks can be considered in resistant cases.

During recovery, the patient should move to a range of motion and strengthening exercises with a gradual increase of activities till he could return to his previous level of athletic activity.

 Surgical Treatment of Retrocalcaneal Bursitis

Surgery is considered in patients who do not show improvement with conservative treatment.

Surgical options include resection of a Haglund deformity, excision of the bursa and debridement of the Achilles tendon insertion

Endoscopic surgery may have better outcomes than open surgical techniques in the treatment of retrocalcaneal bursitis.

The patient should return to sports after resolution of symptoms and signs and if the symptoms do not recur in practice drills.

Prognosis of Retrocalcaneal Bursitis

Most patients of retrocalcaneal bursitis respond well to conservative treatment and those who do not respond to conservative treatment almost always respond to surgery.

Without treatment, the pain may become chronic. Achilles tendon rupture may occur in some cases.

Prevention

Patients with retrocalcaneal bursitis should consider the following preventive measures:

  • Wear proper footwear
  • Change running shoe frequently to avoid the use of worn out shoes
  • Avoid high-heeled shoes.
  • Stretch properly before exercise
  • The proper performance of Achilles tendon stretching

Related

Spread the Knowledge
10
Shares
 
10
Shares
28   

Filed Under: Foot Ankle

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Primary Sidebar

Browse Articles

back massage effective

Back Massage in Back Pain- Does It Help?

Have you ever considered a back massage for back pain? Do you wonder if it is really effective or would help you? Let us find out. Back pain and neck pain are often quite irritating and take time to go. Most of the back pains we have are due to postural abuse of the spine […]

bilateral wrist xrays

Arthritis – Definition, Types, Symptoms and Treatment

Arthritis [Plural – arthritides]  means inflammation in joint. The term includes all the causes of joint inflammation which are about hundred in number. Pain is the most frequent complaint, the pattern of which may differ with arthritis type. Thought arthritis has many causes, the common outcome is the deterioration of joint surfaces and progressive loss of […]

Extensor muscles of hand and forearm

Muscles of Hand and Wrist

There are two groups of muscles of hand – extrinsic muscles and intrinsic muscles. Intrinsic muscles of the hand are those muscles which are located within the hand itself, in contrast to extrinsic muscles which originate proximally in the forearm and insert into the hand by long tendons. Extrinsic muscles are responsible for crude movements […]

Pain Management Program

What is Pain Management Program?

Pain management program is a multi-disciplinary approach that aims at providing pain relief and restoration of normal function by either drugs and/or interventions. Pain management program may be desirable in selected patients of back pain or sciatica, neck pain, failed back syndrome, reflex sympathetic dystrophy, myofascial pain, fibromyalgia, facial pain, neuropathic pain, headaches, cancer pain, shingles, […]

olecranon fractures - Lateral view of the elbow showing olecranon fractures

Olecranon Fracture Persentation and Treatment

Olecranon fracture of olecranon process fracture is a fracture of the large curved eminence called the olecranon process that forms the point of the elbow. It is the point where we rest our elbow on the table in a sitting position. Olecranon is a part of the ulna bone and is the uppermost posterior aspect of the […]

Ankle sprain of second degree, image in PD from W

Ankle Sprain Causes, Symptoms and Treatment

Ankle sprain accounts for up to 40% of all athletic injuries and is most commonly seen in athletes participating in basketball, soccer, running, and ballet/dance. The ankle sprain is usually caused by an inversion-type twisting injury. About eighty percent of acute ankle sprains recover completely, 20% develop mechanical or functional instability resulting in chronic ankle […]

Ischial Bursitis - Location

Ischial Bursitis or Ishiogluteal Bursitis

Ischial bursitis or ischiogluteal bursitis is inflammation of ischiogluteal bursa and is a cause of pain in the buttock. Ischiogluteal bursa is located between the ischial tuberosity and tendon of hamstring muscles at ischial tuberosity. Hamstring muscles during activity produce tension to the hamstring tendon causing friction on the ischiogluteal bursa. During sitting the weight […]

© Copyright: BoneAndSpine.com
Manage Cookie Consent
The site uses cookies. Please accept cookies for a better visiting experience.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}
 

Loading Comments...