Retrocalcaneal bursitis is an inflammatory condition affecting the bursa located under the Achilles tendon, causing pain and swelling around the ankle area. Diagnosis is made through a physical exam, and treatment includes rest, ice, NSAIDs, orthotics, physical therapy, and corticosteroid injections. Surgery is rarely needed.
Retrocalcaneal bursitis, also sometimes called heel insertion pain or Achilles tendon bursitis, is an inflammatory condition. The body has bursae, which are fluid-filled sacs, around most major joints that act as cushions. Retrocalcaneal bursitis specifically affects the bursa located under the Achilles tendon, or at the back of the heel bone, which is called the calcaneus. When the bursa becomes inflamed, it causes pain and swelling around the ankle area.
Patients who suspect they have retrocalcaneal bursitis should examine the heel area to see if it is red and feels warm and tender. They may also notice worsening pain when they stand on their toes. The pain can also intensify when the patient walks, runs or touches the area. Those experiencing these symptoms should see a doctor for a professional diagnosis.
Typically, your doctor will diagnose retrocalcaneal bursitis with just a physical exam. He will examine the ankle for swelling, bending the ankle up and down, while asking the patient about any pain they are experiencing. In cases where the condition doesn’t improve with initial treatment, your doctor may then order imaging tests, such as X-rays and magnetic resonance imaging (MRI).
Retrocalcaneal bursitis is typically a condition of overuse. In other words, the patient likely acquired it by starting an aggressive new exercise routine or suddenly increasing his or her activity level. Running, walking, and jumping in particular can lead to retrocalcaneal bursitis. Initial treatment requires abstaining from strenuous activity or any activity that causes pain. Complete immobilization is usually not recommended.
The doctor will advise the patient to place an ice pack on the ankle area several times a day, for no more than 10 minutes each time. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help relieve pain and reduce swelling. The patient may also use an orthotic, or shoe insert, to provide additional support to the area as they walk. These orthotics are available over the counter or can be custom made to fit an individual’s feet.
Physical therapy is strongly recommended for patients with retrocalcaneal bursitis. The physical therapist can work with the patient on specific exercises aimed at increasing strength and range of motion in the ankle area. Not only can these exercises help the bursa recover, but they can also help prevent the condition from recurring. Some physical therapists may also recommend ultrasound treatment, which can help reduce inflammation. Ultrasound therapy targets high-frequency sound waves at the ankle to stimulate tissue, increase blood flow, and possibly shorten healing time.
Patients who still have retrocalcaneal bursitis despite these treatments can go back to the doctor. Your doctor may inject a corticosteroid drug into the bursa to relieve inflammation. Occasionally, your doctor may recommend placing a cast on your ankle for several weeks. Only in rare cases will surgery be needed to remove the bursa entirely.
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