What is it?

Retrocalcaneal bursitis is the most common type of heel bursitis. It is usually a result of repetitive movements causing minor trauma to the area, including running and jumping. Symptoms include heel pain and tenderness, and evaluation should be performed by a physician for diagnosis. Treatment is aimed at reducing the pain and swelling, with the goal of gradual return to activity.

The retrocalcaneal bursa is a fluid filled sac that occupies the space between the heel (calcaneus) bone and the Achilles tendon. The retrocalcaneal bursa cushions the Achilles tendon as it passes over the heel bone and absorbs impact when walking. Retrocalcaneal bursitis occurs when the bursa becomes inflamed as a result of the Achilles tendon rubbing over the bursa and causing friction against the heel bone. This inflammation can occur after an injury to the area, and it can also occur gradually as a result of repetitive trauma to the bursa from running, jumping or any activity that causes pressure on the heel. Other risk factors for retrocalcaneal bursitis include poorly fitted shoes, tightness in the calf muscles and certain medical conditions including gout, rheumatoid arthritis and fibromyalgia.

 

Symptoms/Risks

Symptoms of retrocalcaneal bursitis can include:

• Heel pain

• Heel tenderness

• Heel swelling

• Ankle Stiffness

 

Sports Medicine Evaluation & Treatment

A sports medicine physician will review the medical history, symptoms and examine the foot and ankle. The provider will pay special attention to the back of the heel deep to the attachment of the Achilles tendon. Due to the location of the bursa, retrocalcaneal bursitis may be misdiagnosed as Achilles tendonitis. The physician may perform imaging studies such as an x-ray or ultrasound. Referral to a physical therapist is often necessary to ensure successful return to activities.

Management of retrocalcaneal bursitis is aimed to reduce the pain and swelling and reduce pressure on the bursa. Treatment of the pain and inflammation can include the following steps:

• Resting from activities that exacerbate symptoms.

• Appling ice to the heel for 20-30 minutes, 3-4 times a day.

• Non-steroidal anti-inflammatory drugs (NSAIDs).

• Wedge orthotics may help with calf tightness by providing heel support.

• Wearing soft shoes with heel and arch support.

• Corticosteroid injections into the bursa can also reduce pain and inflammation.

• If symptoms fail all other treatment methods, surgery can be considered.

 

Injury Prevention

To prevent this injury from recurring, calf stretching and strengthening exercises should be continued after symptoms have resolved. Continuing these measures, along with wearing well-fitting shoes can reduce the risk of recurrence of retrocalcaneal bursitis.

 

Return to Play

Follow these guidelines to restore range of motion and ultimately return to play:

• Daily calf stretches: each of the two calf muscles should be stretched separately, and held for thirty seconds and repeated.

• Strengthening exercises and physical therapy after the pain is adequately controlled.

• Gradual return to activity can be considered when the pain, swelling and stiffness have resolved.

AMSSM Member Authors
Alexander Kim, MD and Crystal Hnatko, DO

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