There are two main bursae involved in heel bursitis, the subtendinous calcaneal bursa and the subcutaneous calcaneal bursa. Both of these bursa are located near the Achilles tendon. The subtendinous
calcaneal bursa, which is also referred to as the retrocalcaneal bursa, is on the back of the heel and is deeply situated between the Achilles tendon and the calcaneus. The subcutaneous calcaneal
bursa, which is commonly referred to as the Achilles bursa, is located near the bottom of the heel between the skin and the distal aspect of the Achilles tendon. It?s much more superficial to the
Achilles tendon than the subtendinous calcaneal bursa.
Retrocalcaneal bursitis is generally caused by local trauma from poorly designed shoes. Patients complain of posterolateral heel pain and may have a posterior heel prominence (?pump bump?), as well
as local swelling and tenderness over the Achilles tendon. Pain is increased by squeezing the bursa from side to side and anterior to the Achilles. A heel lift and open-back shoes help alleviate
Symptoms of bursitis include pain in the heel, especially with walking, running, or when the area is touched. The skin over the back of the heel may be red and warm, and the pain may be worse with
attempted toe rise (standing on tippy-toes).
On physical examination, patients have tenderness at the site of the inflamed bursa. If the bursa is superficial, physical examination findings are significant for localized tenderness, warmth,
edema, and erythema of the skin. Reduced active range of motion with preserved passive range of motion is suggestive of bursitis, but the differential diagnosis includes tendinitis and muscle injury.
A decrease in both active and passive range of motion is more suggestive of other musculoskeletal disorders. In patients with chronic bursitis, the affected limb may show disuse atrophy and weakness.
Tendons may also be weakened and tender.
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.
Surgery is rarely done strictly for treatment of a bursitis. If any underlying cause is the reason, this may be addressed surgically. During surgery for other conditions, a bursa may be seen and