Heel bursitis is specifically the inflammation of the retrocalcaneal bursa, located at the back of the heel, under the Achilles tendon. There are a handful of factors that put you at risk for developing heel bursitis. Long distance runners are prone to heel bursitis, due to repeated stress and pounding upon the heel joint. Engaging in activities such as running, bicycling, walking, jumping, and stair climbing for extended periods of time can overwork the heel joints and start to irritate the bursae. Suddenly changing to a high-intensity workout regime puts a lot of stress on the heel, making it vulnerable to injury. Hard blows/bumps to the heel can immediately damage the bursae, leading to swelling and inflammation. Training at high intensities without stretching and warming up can also contribute to the development of heel bursitis. Even improper footwear can be a big factor. Some other conditions can put you at risk as well, such as: tarsal tunnel syndrome, rheumatoid arthritis, plantar fasciitis, muscle weakness, joint stiffness, and heel spurs. It is very important to get a professional diagnosis if you are having heel pain because heel bursitis is often confused for Achilles tendonitis, and the proper treatments are very different. The pain could also be plantar fasciitis or general heel pain syndrome.
The calcaneal bursa can become inflamed in patients with heel spurs or in patients with poor-fitting shoes (eg, high heels). Inflammation can occur secondarily from Achilles tendinitis, especially in young athletes. Patients exhibit tenderness to palpation of the bursa anterior to the Achilles tendon on both the medial and lateral aspects. They have pain with movement, which is worsened with dorsiflexion.
Your heel may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis. Diagnosis may be confirmed with an ultrasound investigation, MRI or CT scan.
Non Surgical Treatment
Surgery should always be the last option. We believe that biologic treatments that preserve normal anatomy are very helpful, particularly for runner, athletes, and active professionals with buy schedules. All non-surgical approaches attempt to calm down the inflammation of the bursa and Achilles tendon. They do not address the bony bump, but they can substantially reduce and shrink the inflamed soft tissue. Some non-surgical treatments include Oral Anti-inflammatory Medications. NSAID’s (non-steroidal anti-inflammatory medications) such as Motrin, Aleve, and Steroids (like prednisone) may help control the pain and stop the inflammation. Topical Anti-inflammatory Medications. NSAID’s in cream or lotion form may be applied directly to the inflamed area. With these, there is no concern for stomach upset or other problems associated with oral medication. Ice. Ice can applied be applied right to the red, inflamed area and help calm it down. Try applying a podiatrist-approved ice pack to the affected area for 20 minutes of each hour. Just make sure you don’t put ice directly against the skin. Exercises. Stretching exercises may relieve some of the tension in the Achilles tendon that started the problem. If you have Equinus Deformity (or a tight heel cord) this is critical to prevent it from coming back again. Heel lifts. Heel lifts placed inside the shoe can decrease the pressure on the Achilles tendon. Remember, pressure and friction cause the bump to become inflamed. Heel pads. Placing gel padding to cushion the Achilles tendon (at the back of the heel) can also help reduce irritation from shoes. Shoe modification. Wearing open-backed shoes, or shoes that have soft backs. This will also help stop the irritation. Physical therapy. Physical therapy, such as ultrasound, massage and stretching can all reduce the inflammation without surgery. Orthotic devices. Custom arch supports known as foot orthotics control abnormal motion in the foot that can allow the heel to tilt over and rub against the heel counter. Orthotics can decrease symptoms and help prevent it from happening again. Immobilization. In some cases, a walking cast boot or plaster/fiberglass cast is necessary to take pressure off the bursa and tendon, while allowing the area to calm down. ESWT. Extra-corporeal Shock Wave Therapy uses high energy sound waves to break up diseased tissue in the bursa and Achilles tendon and stimulate your own bodies healing processes to repair the diseased area. It may be done in the office or in a an outpatient surgery center. There is no incision and no stitches with ESWT. PRP. Platelet Rich Plasma (PRP) is a therapeutic injection. A small sample of blood is drawn from the patient and the healing factors found in the platelets are concentrated in a centrifuge. By injecting the concentrated solution right into the damaged Achilles tendon, a powerful healing can be stimulated. This can be done in the office. No hospital or surgery required.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.
To prevent bursitis of the heel in the first place, always keep proper form during exercise. In addition, don?t jump into exercises that are too intense without building up to them. Strengthen and flex your ankle.