Bursae are fluid-filled sacs that act as shock absorbers and cushions for our bones and tendons. There are two such sacs located on the back of your heel. The subtendinous calcaneal, also called
retrocalcaneal bursa, is situated between the Achilles tendon and the heel bone (calcaneus). The subcutaneous calcaneal bursa, which is also referred to as the Achilles bursa, is found on the
backside of the heel and Achilles. If either or both of these bursae become inflamed, the result is pain and tenderness.
Overuse of the ankle joint may cause irritation of the bursa such as excessive walking, running or jumping. Poor biomechanics and foot function may ultimately lead to heel bursitis due to pulling on
the back of the heel by the Achilles tendon.
A sudden increase in physical activity without adequate rest may result in heel bursitis. Excessive standing and walking bare foot on hard surfaces.
The signs and symptoms of heel bursitis can include heel pain wearing particular footwear, Pain or discomfort in the heel when walking, jogging or running, Swelling or inflammation in the heel.
In addition to a complete medical history and physical examination, diagnostic procedures for bursitis may include the following. X-ray. A diagnostic test that uses invisible electromagnetic energy
beams to produce images of internal tissues, bones, and organs onto film. Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a
computer to produce detailed images of organs and structures within the body. Ultrasound. A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs.
Aspiration. A procedure that involves removal of fluid from the swollen bursa to exclude infection or gout as causes of bursitis. Blood tests. Lab tests that are done to confirm or eliminate other
Non Surgical Treatment
Surgery should always be the last option. We believe that biologic treatments that preserve normal anatomy are very helpful, particularly for runner, athletes, and active professionals with buy
schedules. All non-surgical approaches attempt to calm down the inflammation of the bursa and Achilles tendon. They do not address the bony bump, but they can substantially reduce and shrink the
inflamed soft tissue. Some non-surgical treatments include Oral Anti-inflammatory Medications. NSAID's (non-steroidal anti-inflammatory medications) such as Motrin, Aleve, and Steroids (like
prednisone) may help control the pain and stop the inflammation. Topical Anti-inflammatory Medications. NSAID's in cream or lotion form may be applied directly to the inflamed area. With these, there
is no concern for stomach upset or other problems associated with oral medication. Ice. Ice can applied be applied right to the red, inflamed area and help calm it down. Try applying a
podiatrist-approved ice pack to the affected area for 20 minutes of each hour. Just make sure you don't put ice directly against the skin. Exercises. Stretching exercises may relieve some of the
tension in the Achilles tendon that started the problem. If you have Equinus Deformity (or a tight heel cord) this is critical to prevent it from coming back again. Heel lifts. Heel lifts placed
inside the shoe can decrease the pressure on the Achilles tendon. Remember, pressure and friction cause the bump to become inflamed. Heel pads. Placing gel padding to cushion the Achilles tendon (at
the back of the heel) can also help reduce irritation from shoes. Shoe modification. Wearing open-backed shoes, or shoes that have soft backs. This will also help stop the irritation. Physical
therapy. Physical therapy, such as ultrasound, massage and stretching can all reduce the inflammation without surgery. Orthotic devices. Custom arch supports known as foot orthotics control abnormal
motion in the foot that can allow the heel to tilt over and rub against the heel counter. Orthotics can decrease symptoms and help prevent it from happening again. Immobilization. In some cases, a
walking cast boot or plaster/fiberglass cast is necessary to take pressure off the bursa and tendon, while allowing the area to calm down. ESWT. Extra-corporeal Shock Wave Therapy uses high energy
sound waves to break up diseased tissue in the bursa and Achilles tendon and stimulate your own bodies healing processes to repair the diseased area. It may be done in the office or in a an
outpatient surgery center. There is no incision and no stitches with ESWT. PRP. Platelet Rich Plasma (PRP) is a therapeutic injection. A small sample of blood is drawn from the patient and the
healing factors found in the platelets are concentrated in a centrifuge. By injecting the concentrated solution right into the damaged Achilles tendon, a powerful healing can be stimulated. This can
be done in the office. No hospital or surgery required.
Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can
cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a
surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to
remove the inflamed bursa.