In the foot we have a unique situation in that between the shoes that we wear and the ground that we walk on various parts of the foot are constantly being ?micro? traumatized meaning that every time
we take a step we do a small amount of damage to a particular part of the foot and eventually that part of the foot begins to hurt. The body?s response to this micro-trauma is to create a bursal sac
to initially protect the area but if micro-traumatized enough the bursal sac itself becomes inflamed and we have a bursitis.
Bursitis is commonly caused by overuse and repeated movements. These can include daily activities such as using tools, gardening, cooking, cleaning, and typing at a keyboard. Long periods of pressure
on an area. For example, carpet layers, roofers, or gardeners who work on their knees all day can develop bursitis over the kneecap. Aging, which can cause the bursa to break down over time. Sudden
injury, such as a blow to the elbow. Bursitis can also be caused by other problems, such as arthritis or infection (septic bursitis).
Pain and tenderness usually develop slowly over time. Applying pressure to the back of the heel can cause pain. Wearing shoes may become uncomfortable. The back of the heel may feel achy. Pain is
exacerbated when the foot is pointed or flexed, because the swollen bursa can get squeezed. A person with retrocalcaneal bursitis may feel pain when standing on their toes. Fever or chills in
addition to other bursitis symptoms can be a sign of septic bursitis. Though uncommon, septic retrocalcaneal bursitis is a serious condition, and patients should seek medical care to ensure the
infection does not spread.
If heel pain has not responded to home treatment, X-rays may be ordered. These images can show deformities of the heel bone and bone spurs that have developed at the attachment of the Achilles. If
there is swelling and/or pain that is slightly higher and within the Achilles tendon itself, an MRI may be ordered to determine if the tendon is simply inflamed or if there is a chronic tear on the
tendon. Aspiration and lab tests. If a septic bursitis is highly suspected, a doctor may perform an aspiration, removing fluid from the bursa with a needle and syringe. In addition to relieving
pressure and making the patient more comfortable, it provides a fluid sample that can be tested for infection.
Non Surgical Treatment
When retrocalcaneal bursitis is associated with tendonitis, it may be necessary to immobilize the ankle for several weeks to allow the Achilles tendon to heal. This can be done by placing a cast on
the ankle, which limits movement and allows the tendon to rest. Walking boots may also be used to limit ankle movement and allow people with retrocalcaneal bursitis to avoid putting pressure on the
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.