Retrocalcaneal bursitis is the painful inflammation and swelling of the retrocalcaneal bursa that is situated between the calcaneus (heel bone) and the Achilles tendon. A bursa is a small fluid
filled sac that forms around joints in areas where there is a lot of friction between muscles, tendons and outcrops of bone. The bursae position themselves in between the tendon or muscle and the
bone, buffering any friction from movement. To picture a bursa imagine it as a very small water filled balloon that sits in places where things rub against each other, such as in between a tendon and
a bone, to provide a soft smooth cushion for the tendon to pass over painlessly. The covering of the bursa also acts as a lubricant and aids the tendon?s movement. It is estimated that there is over
150 bursae in your body which protect the joint and tendons from wear. They are all very small and unnoticeable until they become swollen and painful with bursitis.
The inflammation of a bursa can result from any process that irritates or compresses it. The irritation causes the affected bursa to produce too much fluid and swell. In cases of traumatic injury,
injured capillaries can leak blood into the bursa and cause it to swell.
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.
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
Many times, Achilles tendon bursitis can be treated with home care. However, if self-care remedies do not work, your doctor may need to administer additional treatments. Home care. The most important
thing you can do to help your healing is to refrain from activities that could further aggravate the bursitis. Typical home-care treatments for Achilles tendon bursitis include Anti-inflammatory
medication. Take over-the-counter pain medication, like aspirin or ibuprofen, to reduce pain and swelling. Heel wedges. An over-the-counter or custom heel wedge can be placed in your shoe to minimize
stress in the Achilles tendon. Ice. Apply ice or other cold therapy to your sore heel several times a day. Rest. Limit your activity on the injured leg, avoid putting pressure on it whenever
possible. Also, elevate your leg during non-use to help reduce the swelling. The above remedies may be used on their own or in combination with others on the list. Physician-administered treatments.
If the above self-care remedies are not effective, you should visit your doctor for additional treatment. Possible Achilles tendon bursitis treatments your doctor may administer include
immobilization. If the bursitis is combined with Achilles tendonitis, your doctor may place a temporary cast on the ankle to prevent movement and allow it to heal. Physical therapy. Exercises may be
used to improve the ankle's strength and flexibility. Steroids. Injection of steroids into the retrocalcaneal bursa (not the Achilles tendon) may be necessary. Surgery. In very rare circumstances,
surgery may be needed to remove the retrocalcaneal bursa, however, this is typically a last resort.
You can help to prevent heel pain and bursitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the
heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the
soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.