Retro-calcaneal bursitis

What is it?

Bursa are small fluid filled sacs within the body and are primarily focused on cushioning and lubricating tendons as they pass over bone. As shown in the image below, the Retrocalcaneal Bursa is located between the heel bone (Calcaneus) and the Achilles tendon and is focused on providing this cushioning for everyday activities such as walking and running. However, either through direct trauma or a combination of risk factors, the Retro-calcaneal Bursa can become inflamed/irritated, resulting in a Bursitis. Symptoms of RCB include redness, swelling, stiffness and posterior heel pain (especially with direct pressure or going up on toes).

Why did I get it?

The following factors predispose individuals to Retro-calcaneal Bursitis:

• Direct trauma to heel

• Poor footwear

• Biomechanical foot issues

• Over-use

• Tight calf muscles/Achilles

• Poor running style

Symptoms:

• Heel pain

• swelling around the back of your heel area

• pain when leaning back on your heels

• pain in calf muscles when running or walking

• stiffness

• red or warm skin on back of heel

• loss of movement

• crackling sound when flexing foot

• shoes becoming uncomfortable

How is it diagnosed?

Diagnosis of RCB is generally achieved through a thorough history and clinical examination. Depending on the severity/type of symptoms, you may be referred for an ultrasound or x-ray to rule out further pathology e.g. Insertional Achilles tendinopathy.

Treatments:

• Rest and Ice

• Footwear advice/adjustments

• Rehabilitation program

• Soft tissue release of calf muscles

• Neuromuscular needling

• Anti-inflammatories

• Custom orthotics

• Heel inserts (raises)

Prognosis:

Most patients with RCB recover well (4-6 weeks) providing complete compliance with their respective treatment programs. Corticosteroid injections and surgery are rarely indicated however are options for chronic and unresponsive cases.