Retrocalcaneal Bursitis is an inflammation of the protective sack between the heel bone and the Achilles tendon. It is the inflamed bursa that produces the redness and swelling associated with
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.
Pain when activating the Achilles tendon (running and jumping) and when applying pressure at the point of attachment of the tendon on the heel bone. Contrary to the tenderness occurring with
inflammation of the Achilles tendon, the tenderness is localised to the point of attachment to the heel bone.
If heel pain has not responded to home treatment, X-rays may be ordered. These images can show deformities of the heel bone and bone spurs that have developed at the attachment of the Achilles. If
there is swelling and/or pain that is slightly higher and within the Achilles tendon itself, an MRI may be ordered to determine if the tendon is simply inflamed or if there is a chronic tear on the
tendon. Aspiration and lab tests. If a septic bursitis is highly suspected, a doctor may perform an aspiration, removing fluid from the bursa with a needle and syringe. In addition to relieving
pressure and making the patient more comfortable, it provides a fluid sample that can be tested for infection.
Non Surgical Treatment
Treatments include avoiding painful activities. Over-the-counter pain medications to control inflammation. Icepacks. Ultrasound treatment to reduce inflammation. Physical therapy to improve strength
and flexibility. If other treatments don?t work, your doctor may inject steroids into the area. Surgery is rarely needed.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.
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.