A properly functioning heel is essential to normal, smooth, and painless gait. The heel is the first area to strike the ground during normal gait, which means it takes the brunt of the stress
incurred during walking and running activities. Of course, this also means that the heel is highly prone to injury. One such injury is called heel bursitis.
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.
Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa.
Direct pressure on the bursa will exacerbate the pain and should be avoided if possible. Tenderness and swelling which might make it difficult to wear certain shoes on the feet. As the bursa becomes
more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a "pump bump", and is usually red, and extremely tender. Swelling can cause
difficulties moving as the range of motion in the ankle can be affected. Limping due to the pain may occur. If you press on both sides of the inflamed heel, there may be a firm spongy feeling.
Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads. Possibly a fever if you are suffering from septic bursitis (You
will need to see a doctor for medication to get rid of the infection). Pain at the back of the heel makes it difficult to continue wearing shoes, especially high heels with straps or shoes that don't
During the physical examination of a patient with calcaneal bursitis, the physician should keep the following considerations in mind. Swelling and redness of the posterior heel (the pump bump) may be
clearly apparent. The inflamed area, which may be slightly warm to the touch, is generally tender to palpation. Careful examination can help the clinician to distinguish whether the inflammation is
posterior to the Achilles tendon (within the subcutaneous calcaneal bursa) or anterior to the tendon (within the subtendinous calcaneal bursa). Differentiating Achilles tendinitis/tendinosis from
bursitis may be impossible. At times, the 2 conditions co-exist. Isolated subtendinous calcaneal bursitis is characterized by tenderness that is best isolated by palpating just anterior to the medial
and lateral edges of the distal Achilles tendon. Conversely, insertional Achilles tendinitis is notable for tenderness that is located slightly more distally, where the Achilles tendon inserts on the
posterior calcaneus. A patient with plantar fasciitis has tenderness along the posterior aspect of the sole, but he/she should not have tenderness with palpation of the posterior heel or ankle. A
patient with a complete avulsion or rupture of the Achilles tendon demonstrates a palpable defect in the tendon, weakness in plantarflexion, and a positive Thompson test on physical examination.
During the Thompson test, the examiner squeezes the calf. The test is negative if this maneuver results in passive plantarflexion of the ankle, which would indicate that the Achilles tendon is at
least partially intact.
Non Surgical Treatment
Here are some of the most effective treatments for infracalcaneal bursitis Temporarily avoiding weight-bearing activities that put stress or strain on the heel bone can very helpful in treating
infracalcaneal bursitis. PRICE (protection, rest, hot/cold contrast compresses, compression, and elevation) is another good acute management technique for this foot problem. Changing footwear is an
effective long-term prevention and treatment tool for infracalcaneal bursitis. Shoes that possess a flat support base from heel to toe, a sufficiently wide toe box to accommodate natural toe splay,
and a flexible sole that can be easily bent or twisted are best for preventing and managing infracalcaneal bursitis. An integrated approach to this problem usually involves the use of padded socks or
heel cups to help reduce pressure, friction, and inflammation under the heel. Natural anti-inflammatory agents can also be helpful in quelling inflammation, reducing pain, and improving treatment
times for infracalcaneal bursitis. In rare cases, more aggressive treatment methods may be required, such as cortisone injections or surgery to drain the bursal sac. Always consult your physician
before beginning any healthcare regimen designed to treat infracalcaneal bursitis.
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help