Reviewed by DR. D. DATTA.
Ex. Emergency Medical Officer.
Inflammation of the retrocalcaneal bursa is called retrocalcaneal bursitis.
(Inflammation means swelling, pain, redness or localized rise of temperature in response to some injury)
In the posterior aspect of the upper part of leg there are two calf muscles (gastrocnemius and soleus), at the lower part of the leg they unite to form a band of fibrous tissue that is called Achilles tendon.
The Achilles tendon is inserted into the heel bone (calcaneus also called calcaneum). A small sac of fluid called retrocalcaneal bursa is present above the insertion of the tendon in between the heel bone and tendon. Another bursa present behind the tendon and the skin is called subcutaneous calcaneal bursa. These bursae protect the tendon against rubbing with the heel bone.
Causes of retrocalcaneal bursitis
1 Overuse- Overuse of the ankle or sudden increased activities such as running, jumping, dancing, walking.
2 Poorly fitted shoes causing excessive pressure on the back of heel.
3 In people with Haglund’s deformity- because of the rubbing of the tendon with the heel bone.
( Haglund’s deformity is a bony prominence at the upper part of the calcaneus bone).
4 Some systemic diseases such as rheumatoid arthritis, gout, psoriatic arthritis can cause retrocalcaneal bursitis.
5 Direct trauma at the back of the heel may cause retrocalcaneal bursitis.
6 Rarely infection may cause retrocalcaneal bursitis when bacteria enter into the retrocalcaneal bursa from a cut injury near the heel.
Retrocalcaneal bursitis is common and mainly affects athletes, dancer. General people may also be affected by this disease.
Symptoms of retrocalcaneal bursitis
1 Signs and symptoms of inflammation such as tenderness, pain, swelling, hot feeling and change of color around the back of heel.
2 Stiffness and decreased ankle movement.
2 Increased pain with activities like walking, running, and dancing.
3 Standing on your toes increases the pain.
4 Increased pain when wearing tight shoes and activities with tight shoes that create pressure on the heel bone.
5 Fever when retrocalcaneal bursa becomes infected.
How to diagnose retrocalcaneal bursitis.
1 Proper history taking about symptoms of retrocalcaneal bursitis.
2 physical examination by doctor.
3 When there are symptoms of retrocalcaneal bursitis with fever, bursal fluid aspiration and tests for offending organisms may be done.
4 Imaging for retrocalcaneal bursitis
X ray- x rays cannot detect retrocalcaneal bursa but it can detect any abnormalities of the heel bone that may cause retrocalcaneal bursitis (such as Haglund deformity).
MRI and Ultrasound- These are painless procedures and can differentiate other disorders of achilles tendon from retrocalcaneal bursitis. There will be distention of bursa on ultrasound and MRI.
On MRI the T1 weighted image will show a low signal.
The T2 weighted image will show a high signal.
STIR will show a high signal.
Treatment of retrocalcaneal bursitis
Most retrocalcaneal bursitis respond well with home care and medical management, Surgical intervention rarely indicated.
1 Ice therapy- Application of ice wrapped with a cloth on the painful area for maximum 20 minutes several times a day is helpful for pain relief. Wrap the ice properly to prevent skin damage.
2 Rest- Refrain from or reduce the amount of activities that increase the pain will decrease the inflammation and give the bursa time to heal.
3 Use open back shoes to remove pressure on the heel.
4 A heel cup may be used to prevent friction of the heel with the shoe.
5 Wearing shoe inserts like heel wedges reduces the irritation of retrocalcaneal bursa.
6 Physical therapy under guidance of a physical therapist.
Gentle and gradual stretching of the heel. This will reduce the pressure on retrocalcaneal bursa.
7 Oral or local application of NSAID for short term relief of pain and inflammation.
8 Corticosteroid injection into the bursa can reduce the inflammation and pain in retrocalcaneal bursitis. But it should not be used when there is infection or the achilles tendon is affected with any disease. Corticosteroid injection into the achilles tendon may weaken the tendon and predispose to tendon rupture. It should be done with great precaution as there is a chance of introducing bacteria into the bursa.
9 Ultrasound therapy- It will increase blood flow and cause healing of the bursa.
10 If bursa is hugely swollen then therapeutic aspiration of some bursal fluid can decrease the pain. This procedure may be done under ultrasound guidance.
11 Antibiotics- Antibiotics needed if there is septic retrocalcaneal bursitis.
Surgical treatment is usually not necessary unless other procedures fail.
Surgical treatment involves open or endoscopic resection of the inflamed bursa.
In some situations, like resection of Haglund’s deformity can reduce inflammation and pain.
How to prevent retrocalcaneal bursitis
1 Warm up sufficiently and stretch properly before any sports or physical activity.
2 Gradually increase activities.
3 Wearing perfect shoes that don’t give pressure at the back of the heel.
Achilles tendon rupture.
Achilles tendinitis.
Achilles tendinosis.
Achilles paratenonitis
