Retrocalcaneal bursitis

What is retrocalcaneal bursitis?

Retrocalcaneal bursitis is the result of an inflamed retrocalcaneal bursa in the heel that causes pain and swelling. Also called ankle bursitis or Achilles tendon bursitis, retrocalcaneal bursitis can impact your foot’s movement, especially in the targeted areas of the back of the heel. The painful condition is located in the bursa that connects your heel bone to the Achilles tendon. 

Different forms of bursitis can occur across the body where bursas exist. The purpose of a bursa is to provide cushioning between bones and tendons, so when the fluid-filled sacs become inflamed, any movement in the joints can become painful. Retrocalcaneal bursitis is a common condition among athletes and people who put stress on the heels, like dancers or runners. 

What causes retrocalcaneal bursitis?

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The most common cause of retrocalcaneal bursitis is overuse of the ankle. Repeated strenuous motions of the help can make it so that the foot does not have the chance to rest and recover, leading up to inflammation and swelling. Activities like running, especially running uphill, most often result in retrocalcaneal bursitis. There are other causes of the condition as well, which can contribute to your risk of developing the condition over time. 

Other causes of retrocalcaneal bursitis include:

  • Intense workouts or sudden activity without warmup: If your body is not prepared for an intense workout or any movement outside of your normal scope of activity, you may get retrocalcaneal bursitis. 
  • Wearing tight-fitting or ill-fitting shoes: The wrong footwear can easily cause retrocalcaneal bursitis if the foot either does not have enough support or is squeezed into a shoe that is too small. 
  • Trauma or injury: Retrocalcaneal bursitis can result from an injury to the heel or from damage to the foot that builds over time. 
  • Infection: While rare, an infection may work its way into the bursa and cause the condition. 

What are symptoms of retrocalcaneal bursitis?

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Retrocalcaneal bursitis has common symptoms that affect most people with the condition, but there are a variety of symptoms one with the condition could experience. Symptoms can come and go over time or can be persistent. 

The most common symptoms include: 

  • Intense pain and irritation in the heel at rest or when putting pressure on the heel 
  • Visible redness and swelling of the back of the heel that feels warm to the touch 
  • Radiating pain in the calf muscles when running or walking 
  • Limited and reduced range of motion in the foot
  • Crackling sensation and sound during controlled foot movements, like rotation or flexing 
  • Tenderness of the heel and the surrounding tissue 
  • Fever, in the event of an infection
  • Pain that worsens when you stand on your toes 
  • Stiffness in the foot 
  • Shoes becoming uncomfortable to wear 

Are there any risk factors or groups for retrocalcaneal bursitis?

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While retrocalcaneal bursitis most often affects people who overuse their ankle during sports or daily activities, there are some risk factors that can increase your likelihood of developing the condition. 

The following conditions and risk factors may make someone more likely to develop retrocalcaneal bursitis. 

Rheumatoid arthritis: There is a link between rheumatoid arthritis, a chronic inflammatory condition, and retrocalcaneal bursitis likely because of the connection between the arthritis in the joints that impact the surrounding bursa. 

Haglund’s deformity: Haglund’s deformity is commonly associated with retrocalcaneal bursitis. Haglund’s deformity is characterized by an irregular bump on the heel that causes swelling and pain in the heel and Achilles tendon, creating a higher risk for the inflammation of the bursa in the heel. 

Psoriatic arthritis: Similar to rheumatoid arthritis, those with psoriatic arthritis are more likely to develop retrocalcaneal bursitis due to the predisposition to inflammation in the joints. 

Gout and pseudogout: Gout and pseudogout can increase your risk of retrocalcaneal bursitis due to the painful buildup of uric acid that can flare and cause injury or discomfort in the heel. 

Ankylosing spondylitis: Another form of arthritis ankylosing spondylitis typically impacts the spine but can lead to retrocalcaneal bursitis if the inflammation spreads down the spine to the ankles and heels. 

Other risk factors include age and regular activities. Those aged 65 years and older are at a higher risk of developing the condition. In addition, those who frequently engage in activities that put pressure on the heel without proper warm up or strength put themselves at a higher risk of the condition.

How is retrocalcaneal bursitis diagnosed?

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You will need to see a doctor to confirm a retrocalcaneal bursitis diagnosis and to rule out the presence of other conditions. The primary care physician will begin by reviewing your health history, hearing about the type and frequency of symptoms, and getting a sense of your daily activities. This review will help inform a physical examination of your feet to understand your risk of retrocalcaneal bursitis and the probable cause of the condition, if diagnosed. 

Your doctor will check your feet for swelling, tender areas, and range of motion. They may also assess your heel for symptoms of infection. If there are signs of an infection, your doctor may take steps such as taking your temperature and taking a sample of the fluid in the bursa to test for presence of an infection-causing bacteria. In the absence of symptoms of infection, your doctor may be able to confirm a retrocalcaneal bursitis diagnosis with a health history review and a physical examination. However, your doctor may need imaging tests to verify. 

 

X-rays and MRIs are two imaging tests that help give your doctor a more detailed view of your heel, including the bone and surrounding tissue to confirm the condition and any related complications. Imaging tests typically can pinpoint more serious injuries or injuries that are not observable through external physical exams. 

How is retrocalcaneal bursitis treated?

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Retrocalcaneal bursitis is a treatable condition with minimally invasive treatments. The treatments are designed to allow the bursa to heal while reducing pain and inflammation. For many people, the condition clears over time with proper rest and good daily habits. For others, more involved treatments like surgery may be necessary. 

 

Home Treatments: 

Rest: Rest can be the most important part of a retrocalcaneal bursitis treatment plan. Giving your feet a rest from the activities that caused the condition and that might be aggravating it is essential. Stick to low impact exercises that reduce the stress on your heel while the bursa recovers. 

Pain Medications: OTC pain relievers like NSAIDS may help to manage the pain associated with the condition. Other topical pain relievers like gels or creams can help. 

Ice and Heat: Alternative heat and ice on the impacted heel aids in reducing inflammation and manages the pain at the onset of the condition. 

Stretching: Gentle stretching and range of motion movements can keep your heel mobile while it restores strength and functionality. 

Footwear: Picking supportive footwear that fits right and adds extra cushion can go a long way to treating retrocalcaneal bursitis effectively. 

 

Medical Treatments:

Physical Therapy: Your doctor may prescribe physical therapy sessions to work with a therapist to stretch the heel and tendons as well as strengthen the foot. 

Steroid Injections: Steroid injections involve injecting anti-inflammatory agents directly into the heel for pain relief. 

Surgery: Surgery is very rarely necessary for those with retrocalcaneal bursitis but can be an option of last resort if no other treatment works.

Should you see a doctor for retrocalcaneal bursitis?

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Without a proper diagnosis and treatment, retrocalcaneal bursitis can get worse before it gets better, so be sure to seek medical care when you notice symptoms. Doctors who specialize in conditions of the foot are best able to help diagnose your condition and work with you to come up with an effective treatment plan to let your foot heal. Keeping track of your symptoms and activities that you notice worsen your foot pain is useful in diagnosing the condition. Seeking the care of a doctor is the best way to handle retrocalcaneal bursitis. 

You should seek immediate medical attention if you have a fever at or above 100.4℉ and are experiencing other symptoms of infection such as chills, pain that worsens, and excessive swelling in the heel area. If there is infection present, a medical professional needs to promptly diagnose the infection and prescribe antibiotics.

What is the outlook for people living with retrocalcaneal bursitis?

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Retrocalcaneal bursitis has a positive outlook because the condition is treatable and typically does not require any invasive treatments to resolve. Early diagnosis of the condition can help expedite treatment and let the bursa heal properly. While there can be lingering symptoms of retrocalcaneal bursitis such as limited range of motion, there are no major complications of the condition. 

You can take appropriate steps to try and prevent the condition by wearing the right shoes and being sure to warm up before strenuous activity. If you notice new symptoms, be sure to communicate as soon as you can with your primary care physician to diagnose your condition and start treatment. 

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