Heel Bursitis is a condition where one of the bursae at the back of the heel becomes swollen, inflamed and painful. A bursa is a fluid filled sac that cushions muscles, tendons and joints. There are
3 main types of bursitis associated with heel bursitis. These include Retro-calcaneal bursitis, Achilles bursitis, and Sub-calcaneal bursitis. The locations of the 3 bursae are: the insertion point
of the Achilles tendon at the back of the heel (retro-calcaneal bursa), between the Achilles tendon and the skin at the back of the heel (Achilles bursa), and the bottom of the heel (sub-calcaneal
As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions.
Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It
is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.
Some of the symptoms of bursitis in the heel, or retrocalcaneal bursitis, are as described below. Severe pain in the heel area of the foot, sometimes radiating to the ankle, associated with physical
activities like walking, jogging and even on physical contact to the area. The physical signs of heel bursitis, which are noticeable in the heel area, are reddish discoloration of the skin that is
warm to touch.
On physical examination, patients have tenderness at the site of the inflamed bursa. If the bursa is superficial, physical examination findings are significant for localized tenderness, warmth,
edema, and erythema of the skin. Reduced active range of motion with preserved passive range of motion is suggestive of bursitis, but the differential diagnosis includes tendinitis and muscle injury.
A decrease in both active and passive range of motion is more suggestive of other musculoskeletal disorders. In patients with chronic bursitis, the affected limb may show disuse atrophy and weakness.
Tendons may also be weakened and tender.
Non Surgical Treatment
Most bursitis cases can be treated by the patient without having to see a doctor. A trip to a pharmacy, a conversation with the pharmacist, and some self-care techniques are usually enough. The NHS
(National Health Service, UK) recommends PRICEM, a self-care management approach. PRICEM stands for Protection. Rest. Ice. Compression. Elevation. Medication. Protect the affected area, Some people
place padding to protect the affected bursae from any blow. Rest. Do not exercise or use the joints in the affected area unless you really have to. Let it rest. Bursitis is a condition that responds
well to rest. Ice packs. Ice packs can help reduce pain and inflammation. Make sure you do not place the ice directly on the skin, use a pack or towel. A small pack of frozen vegetables are ideal.
Raise the affected area. If you can, lift the affected area, raise it, less blood will gather there. This may help reduce the inflammation. Painkillers. Ibuprofen is an effective painkiller for
treating pain, it also reduces inflammation. Steroids. For more severe symptoms the doctor may inject steroids into the affected area. Steroids block a body chemical called prostaglandin.
Prostaglandin causes inflammation. Steroids may raise the patient's blood pressure if used for too long, as well as increasing his/her risk of getting an infection. UK doctors are advised not to give
more than three steroid injections in one year. Antibiotics. If the fluid test confirms that there is a bacterial infection, the doctor will probably prescribe antibiotics. These will be administered
orally (via mouth).
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.
Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular
stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.