Retrocalcaneal Bursitis

Retrocalcaneal bursitis is a heel pain condition which involves inflammation of the fluid-filled sac at the back of the heel bone, under the Achilles tendon. The name comes from “retro” which means behind, “calcaneus” which is the heel bone, and “bursa” which is the sac. The bursa’s purpose is to act as a lubricant and cushion between the Achilles tendon and the heel bone. Bursae are found around most large joints in the body, reducing friction where muscles and tendons slide over bone.

Causes

Retrocalcaneal bursitis is usually caused by repetitive or cumulative trauma to the area where the bursa is found, for example from walking or running. There are many factors which increase the risk of retrocalcaneal bursitis, among which is the presence of a Haglund deformity (also known as a “pump bump”). Haglund’s Deformity is a bony prominence at the back of the heel, caused by shoes with rigid backs, for example women’s pumps. This condition increases the likelihood that shoes will put pressure on the back of the heel, which in turn increases the risk of retrocalcaneal bursitis.

Other factors which could aggravate the situation are: poorly fitting footwear, especially shoes that are too tight; joint stiffness; muscle weakness; poor flexibility; overtraining in athletes or training without doing proper stretching first; abnormal foot biomechanics like pronation, supination, flat feet, high arches and a tight or short Achilles tendon. Retrocalcaneal bursitis is sometimes also associated with conditions like gout, rheumatoid arthritis, seronegative spondyloarthropathies, and Achilles tendonitis (sometimes called Achilles tendinitis).

Retrocalcaneal Bursitis

A view of the heel bone, the bursa, and the Achilles tendon.

Symptoms

The main retrocalcaneal bursitis symptoms are heel pain when doing activities with repetitive calf contractions like walking, running, jumping, and going up and down stairs. The pain is sometimes worse with rest after these activities, especially during that night or the following morning. The heel pain might also increase when starting exercise after a period of inactivity.

Other symptoms are heel pain that worsens if you rise up on your tiptoes or if you squeeze the heel. The heel might also be swollen and tender to the touch, with skin that is red and warm. Retrocalcaneal bursitis can appear in one foot or both feet, and though a pump bump can increase the risk, the presence of one does not necessarily mean you have retrocalcaneal bursitis.

Treatment

Basic treatment for retrocalcaneal bursitis is the R.I.C.E. method (rest, ice, compression, and elevation). Painkillers are not recommended, as in most cases artificially masking the pain of a repetitive stress injury will result in further damage. Instead, an anti-inflammatory cream like Penetrex that treats the root cause of the pain will reduce discomfort while aiding the healing process.

Rest from any all activities that increase the pain is very important so that the bursa can begin to heal without being damaged further. You can resume these activities when the symptoms disappear, but be sure to start slowly and increase gradually. In the meantime you can do other activities to keep in shape that won’t further irritate the bursa, for example swimming or water aerobics.

Ice can be applied to the bursa area a few times per day for no longer than 20 minutes at a time. Do not apply the ice directly to the skin – rather wrap it in a wet tea towel first.

If your shoes are aggravating the retrocalcaneal bursitis, it would be a good idea to change your footwear to something that won’t irritate the bursa, for example open-backed shoes. Low heel wedges can also help relieve pressure on the heel.

Your doctor may also other recommend non-steroidal anti-inflammatory medication, physical therapy, or in severe cases surgery. With proper treatment, most people recover from retrocalcaneal bursitis in just a few weeks. To prevent it’s return, always wear well-fitting appropriate footwear and be sure to stretch properly before exercising.