Retrocalcaneal bursitis

Are you experiencing pain by the bottom of the back of your heel? Then you may be suffering from a common heel condition called Retrocalcaneal Bursitis.

Juhi Modi Medical Writer


Retrocalcaneal bursitis is a medical condition that causes heel pain. It can be a debilitating problem, making it difficult for you to walk and go about your day-to-day activities. You may have severe pain and swelling in the heel. Your heel might feel tender to touch. Some types of shoes may become difficult to wear. But you don’t have to live with retrocalcaneal bursitis. We’re here to help you deal with it through this informative guide.

Heel pain is more common than you might think. Not surprisingly, it affects runners and ballet dancers, but it is also present in about 10 percent of the general population. About one-third of elderly people above the age of 65 have heel pain.

One of the causes of heel pain is retrocalcaneal bursitis. This is a treatable condition that can be managed and resolved with exercise. Other treatment options are also available.

At Injurymap, we understand how uncomfortable retrocalcaneal bursitis can be. We are committed to helping you live pain-free through this comprehensive guide.

What is retrocalcaneal bursitis?

It sounds like a mouthful, so let’s break down the term retrocalcaneal bursitis. First, some definitions. Calcaneus is the medical name for the heel bone. It is a large bone that forms the back of the foot. A bursa is a sac of fluid that provides lubrication, reduces friction, and facilitates movement between different surfaces in the body. There are many bursas present in the body, usually near large joints. Repeated or excessive use of a joint can cause a bursa to become inflamed and irritated.

Bursae of the foot

The retrocalcaneal bursa is, as the name suggests, a bursa located behind the calcaneus bone. It provides cushioning between the calcaneus bone and the Achilles tendon (the thick heel cord you can feel at the back of your foot).

Finally, any medical term ending in -itis denotes inflammation. Retrocalcaneal bursitis is an inflammation of the bursa behind the calcaneus bone in the heel of the foot.

Symptoms of retrocalcaneal bursitis

The main symptom of retrocalcaneal bursitis is heel pain. The pain is typically located at the back of the heel and occurs especially with walking, running, and jumping. You may experience pain when leaning on your heel, for instance, while sitting with your heels flat on the ground.

The pain is sometimes worse when you stand up on your tiptoes, as this places pressure on the heel. The area of the heel may feel tender to touch.

Other symptoms of retrocalcaneal bursitis

  • redness
  • warmth
  • swelling of the skin at the back of the heel
  • a crackling sound when bending the foot toward the leg
  • discomfort with wearing tight-fitting shoes1

Causes of retrocalcaneal bursitis

Inflammation of the retrocalcaneal bursa is most commonly caused by overuse or repetitive trauma. It can also be aggravated by pressure, for example, from tight-fitting athletic shoes. If you’ve recently started an intense workout regimen (training with uphill runs, for example) and are experiencing heel pain, it could be due to retrocalcaneal bursitis.

One of the risks of retrocalcaneal bursitis is a sudden increase in activity without proper conditioning, which puts stress on the ankle joint. This can lead to excessive friction and repetitive rubbing of the Achilles tendon against the retrocalcaneal bursa, causing inflammation and irritation of the bursa. People who don’t stretch and warm up properly are at higher risk of developing retrocalcaneal bursitis. The condition can also occur in folks with a history of arthritis.1

Retrocalcaneal bursitis is sometimes mistaken for another similar condition called Achilles tendonitis, which is an inflammation of the Achilles tendon. If you’re experiencing pain at the back of your heel and treatment for Achilles tendonitis has not helped, you might be suffering from retrocalcaneal bursitis instead.

Achilles tendonitis vs Retrocalcaneal bursitis
There is a subtle difference in symptoms. Tenderness from retrocalcaneal bursitis is typically present on the sides of the heel cord. A physician or physiotherapist can determine which of these two conditions is present with the help of a careful examination.

A definitive diagnosis can be made with imaging studies, such as ultrasound, MRI, or CT scan. Remember, you may have both conditions at the same time.2

How long does it take for retrocalcaneal bursitis to heal?

In the majority of people, retrocalcaneal bursitis can be managed in about six weeks. Heel pain is the main reason most people seek treatment for retrocalcaneal bursitis. It is the final symptom to develop and the first symptom to go away.3

Can you recover completely from retrocalcaneal bursitis?

Inflammation of the retrocalcaneal bursa is a treatable condition that will go away with the proper conservative care. Most people respond well to treatment for retrocalcaneal bursitis.

Many cases of retrocalcaneal bursitis can be treated with exercises at home. However, it’s important not to stop doing your rehab exercises when the pain improves.3

When to see a doctor for heel pain?

Complications of retrocalcaneal bursitis can include infection of the bursa and/or limited range of motion in the affected ankle joint, so it’s important to get professional help. You should seek medical care from a healthcare professional if you are running a fever of more than 100.4 Fahrenheit (38 degrees Centigrade) or if your heel pain is worsening, the symptoms are not improving, or you have developed new symptoms.4

Swollen retrocalcaneal bursat

Treatment for retrocalcaneal bursitis

Doctors recommend resting and reducing or avoiding activities that cause pain for a short period. Applying ice to the heel for 15-20 minutes each several times a day during the acute phase of retrocalcaneal bursitis can help ease symptoms. If the pain does not allow you to remain active by walking or running, you should consider alternative means of maintaining strength and fitness, such as swimming and water aerobics.5

Besides rest and icing for symptom relief, rehab exercises are an effective treatment for retrocalcaneal bursitis. Gradual stretching of the heel improves flexibility and relieves impingement on the bursa, leading to an improvement in symptoms.5 Experts recommend a gradual increase in rehab exercises to return to the previous level of functioning, pain-free.

Best exercises for retrocalcaneal bursitis

Always start with a warm-up and gradually work up the intensity and frequency of your stretching and exercise regimen for heel pain.

  1. Achilles tendon stretch

    Achilles tendon stretch
    30 sec. x 3 sets

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    • Stand with bare feet.
    • Place your toes up against a wall.
    • Bend the knee a little and move it towards the wall.
    • You should feel it stretching at the bottom of the back of the heel and in the arch of the foot.
    • Hold the stretch for 30 seconds and perform 3 repetitions with each leg.
  2. Heel lift on a flat surface

    Heel lift on a flat surface II
    15 reps x 3 sets

    This browser does not support the video element.

    • Stand up.
    • Lift yourself up on your toes with both legs.
    • Move your weight to one of your legs and slowly lower your heel back down.
    • Perform 3 sets of 15 repetitions.
  3. Heel lift with bent knees

    Heel lift with bent knees I
    5 reps

    This browser does not support the video element.

    • Stand with your feet slightly apart.
    • Your toes should point straight ahead.
    • Slowly move your knee past the toes so that your ankle and knee bends.
    • Move the knees forward as far as possible, so that the ankle is bent to a maximum.
    • You should feel it tightening in the back and front of the ankle, but it should not hurt.
    • Keep your knees bent while slowly raising your heels, so that you're standing on your toes.
    • Hold your balance for a few seconds then slowly lower your heels again.
    • Perform 5 repetitions.

Other treatment options for retrocalcaneal bursitis

Taping

Your physical therapist may suggest taping the heel area to help with retrocalcaneal bursitis. This provides stabilization and decompresses the area of pain. The taping, which is placed over the back of the heel, can be worn for 5-7 days for relief of symptoms.6

Medications

Pain and other symptoms associated with retrocalcaneal bursitis can be managed with medications, typically oral non-steroidal anti-inflammatory drugs, called NSAIDs for short. You probably know these drugs as commonly prescribed painkillers, such as ibuprofen and naproxen. They are used in conjunction with an exercise rehab program to provide relief from symptoms of retrocalcaneal bursitis. Topical NSAIDs, such as a diclofenac cream or ointment, may sometimes be prescribed to provide relief in the local area of pain in the heel.5

Corticosteroid Injections

Corticosteroid and anesthetic injection into the retrocalcaneal bursa may be considered with x-ray or ultrasound guidance13,14. This has been shown to reduce pain by 50 percent in approximately 7 out of 10 patients.7 However, steroid injections to control pain and inflammation due to retrocalcaneal bursitis should generally only be performed, when there is no Achilles lesion in conjunction. This is because the steroid injected into the retrocalcaneal bursa can spread to the adjacent Achilles tendon and lead to a further weakening of this tendon and a potential rupture.8

Shoes and footwear

Changing your footwear may be an important component of managing retrocalcaneal bursitis. You should consider wearing open-backed footwear for some time as this will relieve pressure on the heel. Sometimes, retrocalcaneal bursitis symptoms develop when you suddenly switch from high heels to flat shoes or vice versa. It may be a good idea to wear a medium heel temporarily to relieve symptoms.

Athletes should purchase well-fitting shoes regularly because the support and fit can change over time, especially with heavy use. Your physiotherapist may suggest inserting a heel cup to keep the inflamed heel from touching the back of your shoe.

It’s worth noting that studies have found orthotic shoe inserts (insoles or heel inserts) are not particularly effective in preventing overuse injuries.5 Most people do not need special orthotics in any case and should simply wear supportive, comfortable shoes.

Surgery

Surgical interventions are rarely performed for retrocalcaneal bursitis. However, surgery may be necessary for people who have persistent or progressive symptoms that do not get better with nonsurgical treatments such as rest/icing, rehab exercises, and change in footwear5.

Surgical procedures done to relieve symptoms
  • Excision (removal) of the painful bursa
  • Endoscopic removal of the inflamed bursa (this is a minimally invasive procedure performed by inserting a long, thin tube called an endoscope into the heel)
  • Resection (removal) of a Haglund deformity, which is a bony prominence in the calcaneal area
  • Repair of Achilles tendon rupture

If you have retrocalcaneal bursitis that has not responded to conservative treatments such as icing and rehab exercises, you may need to see an orthopedic surgeon with experience in foot and ankle conditions. The orthopedic surgeon will be able to tell you if you could benefit from surgical treatments for retrocalcaneal bursitis.

How can I prevent retrocalcaneal bursitis from recurring?

Always wear properly fitting footwear that does not place stress on the heel, as this can lead to inflammation of the bursa. Avoid wearing high-heeled shoes and footwear that hugs the back of the heel too tightly. Change your athletic shoes regularly (depending on how much you use them).5

Always warm-up and stretch well before you begin a workout to reduce the chances of a recurrence. When starting a new exercise regimen, ease into it gently rather than suddenly diving into a very intense program.1 The Injurymap app will show you the proper form and technique for heel exercises. Use the app regularly to maintain good flexibility and develop strength in your ankle joint to help prevent retrocalcaneal bursitis.

Heal That Pain…

Heel pain is preventable and treatable and there’s no reason for you to suffer. Don’t ignore your symptoms, as they can sometimes become chronic (longstanding) and progressive, resulting in limping and decreased functionality. At Injurymap, we have a range of exercises and stretches that will keep your ankle joint and heel flexible, injury-free, and pain-free. While we’ve listed some of the best rehab exercises for heel pain here, the Injurymap app has hundreds of exercises for every muscle and joint in the body.

It’s a good idea to start slowly and gradually increase your reps and resistance. Our exercises have been developed by experts and the app creates a custom made program for you that gradually increases the difficulty of your exercises. If you have any questions about the heel pain exercises or any other exercises in the Injurymap app, do not hesitate to contact us. You can start with the sample program and see how it goes.

We understand heel pain can be difficult to live with, but it doesn’t have to be that way. Our goal at Injurymap is to make physical therapy accessible to you in your home as the mainstay of treatment for heel pain due to retrocalcaneal bursitis.

References


  1. https://medlineplus.gov/ency/article/001073.htm 

  2. https://www.coreconcepts.com.sg/article/when-is-achilles-tendonitis-not-achilles-tendonitis-when-it-is-retrocalcaneal-bursitis/ 

  3. https://physioworks.com.au/injuries-conditions-1/retrocalcaneal-bursitis 

  4. https://www.saintlukeskc.org/health-library/understanding-retrocalcaneal-bursitis 

  5. https://emedicine.medscape.com/article/86297-treatment#d10 

  6. https://www.youtube.com/watch?v=xudX9eopeA4 

  7. https://reference.medscape.com/medline/abstract/27020450 

  8. https://reference.medscape.com/medline/abstract/28765268 

  9. https://emedicine.medscape.com/article/307562-treatment#d9 

  10. http://www.sompar.nhs.uk/media/4678/fact-sheet-musculoskeletal-eccentric-heel-drop-exercise-protocol-insertional-achilles-final-061115.pdf 

  11. https://www.ncbi.nlm.nih.gov/pubmed/18184750 

  12. https://www.injurymap.com/exercises/rWPol9xGVAlo 

  13. https://www.appliedradiology.com/articles/fluoroscopically-guided-retrocalcaneal-bursa-steroid-injection-efficient-and-effective 

  14. http://www.jrheum.org/content/38/2/391 

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About the author

Juhi Modi has two decades of experience as a medical writer with varied interests and an enduring passion for health, biology, and science. She uses her educational background in medicine to write science-backed articles for clients around the world.