Achilles Bursitis (Retrocalcaneal Bursitis)

Retrocalcaneal bursitis happens when the bursae around your heel become inflamed. Bursae are fluid-filled sacs that form around your joints. The bursae near your heels are behind your Achilles tendon, right above where it attaches to your heel bone.

Overuse from walking, running, or jumping can all cause retrocalcaneal bursitis. It’s common in athletes, especially runners and ballet dancers. Doctors sometimes misdiagnose it as Achilles tendonitis, but the two conditions can happen at the same time.

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The most common cause of retrocalcaneal bursitis is overusing the heel and ankle area. A quick increase in physical activity or not warming up properly before exercising can both cause this.

Exercising in poor-fitting shoes or walking in high heels may also cause retrocalcaneal bursitis. If you already have bursitis, wearing these types of shoes can also worsen it.

In some cases, arthritis can cause retrocalcaneal bursitis. Rarely, an infection may also cause it.

Other possible causes include:

  • gout
  • Haglund’s deformity, which may coexist with retrocalcaneal bursitis

You might be more at risk for developing retrocalcaneal bursitis if you:

  • are over 65 years old
  • participate in high-activity sports
  • don’t stretch properly before exercising
  • have tight muscles
  • have a job that requires repeated movement and stress on the joints

The risk of developing bursitis in this way is greater for those whose jobs or hobbies involve repetitive movements. Examples of this are carpet fitters and gardeners who spend significant time kneeling and therefore are more at risk of bursitis in the knee; likewise, runners have a greater likelihood of developing bursitis in the hip.

The main symptom of retrocalcaneal bursitis is heel pain. You might only feel pain when you put pressure on your heel.

Other symptoms may include:

  • 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

Your doctor will examine your foot and heel to check for any signs of tenderness, redness, or heat. They may use an X-ray or MRI to rule out a fracture or more serious injury. In some cases, your doctor might take fluid from the swollen area to test it for an infection.

Retrocalcaneal bursitis usually responds well to home treatments. These include:

  • resting your heels and ankles
  • elevating your feet
  • icing the area around your heels several times a day
  • taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)
  • wearing a shoe with a slightly elevated heel

Your doctor may also recommend over-the-counter or custom heel wedges. These fit in your shoe under your heel and help raise both sides. They help reduce stress on your heels.

If home treatments and shoe inserts don’t help, your doctor may recommend a steroid injection if it’s safe to do so. They’ll consider the risks of a steroid into this area, such as rupture of the Achilles tendon.

Your doctor might also have you wear a brace or cast if you also have Achilles tendonitis. Physical therapy can also help strengthen the area around your heel and ankle. In rare cases, you might need surgery to remove the bursa if other treatments don’t work.

Make sure to contact your doctor if you have any of the following symptoms. These may indicate an infection in your heel:

  • excessive swelling or rash around the heel area
  • heel pain and fever of over 100.4°F (38°C)
  • sharp or shooting pain

There are a few easy steps you can take to avoid getting retrocalcaneal bursitis:

  • Stretch and warm up before working out.
  • Use good form when exercising.
  • Wear supportive shoes.

Strengthening your foot muscles can also help.

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