Retrocalcaneal Bursitis. This bursa is located at the back of the heel. Bursitis in this area is often associated with conditions such as ankylosing spondylitis or rheumatoid arthritis. It can occur
in healthy individuals who wear improperly fitted shoes. Symptoms include painful swelling that develops at the back of the heel. Calcaneal Bursitis. This bursa is located at the sole or bottom of
the heel. Inflammation usually produces pain in the heel when standing. Causes include heel spurs, excess weight, injury, and wearing improperly fitted shoes.
The most common causative organism is Staphylococcus aureus (80% of cases), followed by streptococci. However, many other organisms have been implicated in septic bursitis, including mycobacteria
(both tuberculous and nontuberculous strains), fungi (Candida), and algae (Prototheca wickerhamii). Factors predisposing to infection include diabetes mellitus, steroid therapy, uremia, alcoholism,
skin disease, and trauma. A history of noninfectious inflammation of the bursa also increases the risk of septic bursitis.
The following are the most common symptoms of bursitis. However, each individual may experience symptoms differently. Bursitis can cause pain, localized tenderness, and limited motion. Swelling and
redness may occur if the inflamed bursa is close to the surface (superficial). Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness, which may lead to the deterioration of
muscles and a limited range of motion. The symptoms of bursitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
Your health care provider will take a history to find out if you have symptoms of retrocalcaneal bursitis. Examining your ankle can find the location of the pain. The physician will look for
tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex). Or, the pain may be worse when you rise on your toes. You will not usually
need imaging studies such as x-ray and MRI at first. If the first treatment does not improve the symptoms, your health care provider may recommend these tests. MRI may show inflammation.
Non Surgical Treatment
With posterior Achilles tendon bursitis, treatment is aimed at reducing the inflammation and adjusting the foot's position in the shoe to relieve pressure and motion on the back of the heel. Foam
rubber or felt heel pads can be placed in the shoe to eliminate pressure by elevating the heel. Placing protective gel padding over the painful bursa or stretching the back part of the shoe and
placing padding around the inflamed bursa may help. Sometimes a special shoe, such as a running shoe designed to stabilize the midsole heel, devices placed in the shoe (orthoses), or both can help to
control abnormal foot and heel motion contributing to the posterior heel irritation. Other shoes have padding that reduces irritation to the posterior heel and Achilles tendon.
Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can
cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a
surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to
remove the inflamed bursa.