The heel is the portion of the human body that is located at the bottom rear part of each foot. Its exterior shape is formed by the calcaneus, also known as the heel bone. The calcaneus is the bone that forms the heel of the foot. It’s one of the tarsals, the bones that make up part of the foot and ankle. The calcaneus is the largest bone of the foot and provides the foundation for all the other tarsals and metatarsals. The calcaneus strikes the ground with every football when running or walking. Stress fractures of the calcaneus and inflammation of the plantar fascia ligament that is attached to the calcaneus are two of the most common causes of foot pain.
The Retrocalcaneal bursa is a certain fluid-filled sac that occupies the space between the heel bone and the Achilles tendon. The Retrocalcaneal bursa cushions the Achilles tendon as it passes over the heel bone and absorbs impact when walking. Retrocalcaneal bursitis occurs when the bursa becomes inflamed as a result of the Achilles tendon rubbing over the bursa and causing friction against the heel bone.
This inflammation can occur after an injury to the area, and it can also occur gradually as a result of repetitive trauma to the bursa from running, jumping, or any activity that causes pressure on the heel. Other common factors for Retrocalcaneal bursitis include poorly fitted shoes, tightness in the calf muscles, and certain medical conditions including gout, rheumatoid arthritis, and fibromyalgia. Additionally, Retrocalcaneal bursitis is often associated with other serious problems in the heel, such as Achilles tendonitis and Haglund deformity.
Causes & Symptoms
Inflammation of the Retrocalcaneal bursa is most commonly caused by overuse or repetitive trauma. It can also be aggravated by pressure, for example, from tight-fitted athletic shoes. If you have recently started an intense workout regimen (such as training that includes uphill running) and are experiencing heel pain, it could be due to Retrocalcaneal bursitis. One of the risks of Retrocalcaneal bursitis is a sudden increase in activity without proper conditioning, which puts stress on the ankle joint. This can lead to excessive friction and repetitive rubbing of the Achilles tendon against the retrocalcaneal bursa, causing inflammation and irritation of the bursa. People who do not stretch and warm up properly are also at a higher risk of developing Retrocalcaneal bursitis.
Retrocalcaneal bursitis is sometimes mistaken for another similar condition known as Achilles tendonitis, which is an inflammation of the Achilles tendon. If you’re experiencing pain at the back of your heel and treatment for Achilles tendonitis has not helped, you may be suffering from retrocalcaneal bursitis instead.
In addition to pain, there are several other possible signs and symptoms of Retrocalcaneal bursitis; a person with this type of heel bursitis may notice one or more of the following signs, including:
- Swelling at the back of the heel – Bursitis causes a bursa to fill with excess fluid. In Retrocalcaneal bursitis, this excess fluid may cause visible swelling in the area just above the back of the heel bone. The swelling caused by this condition (the form of heel bursitis associated with wearing tight shoes) may be more distinct, appearing as a hard lump behind the heel.
- Stiffness – The swelling at the back of the heel may make it difficult to fully bend or straighten the ankle.
- Skin redness – Retrocalcaneal bursitis can cause the skin at the back of the heel to look red. This discoloration is more likely to occur in Retrocalcaneal bursitis because the calcaneal bursa is closer to the surface of the skin. The skin at the back of the heel may also appear red skin if it has been irritated by wearing ill-fitting shoes.
- Fever or chills – A body-wide fever or chills is a sign of infection. When fever or chills appear with other heel bursitis symptoms, especially hot, red skin at the back of the heel, it may be a sign of septic bursitis.
Generally, in the majority of people, Retrocalcaneal bursitis can be managed in about six weeks. Heel pain is the main reason most people seek treatment for Retrocalcaneal bursitis – it can often be the final symptom to develop and the first symptom to go away.
Who gets Retrocalcaneal Bursitis?
Certain movements and everyday habits can cause repetitive heel irritation that triggers Retrocalcaneal bursitis. People with heel bursitis often report one or more of the following risk factors:
- Using the ankle excessively – Retrocalcaneal bursitis is often caused by frequent mini traumas. These mini traumas are often due to excessive walking, jumping, and running. Running uphill, which causes the foot to flex considerably, can be especially irritating to the retrocalcaneal bursa.
- Increasing exercise intensity rapidly – Starting an exercise program without adequate stretching and muscle conditioning may lead to Retrocalcaneal bursitis. Intense exercise can put a strain on the calf muscles and the Achilles tendon, including the enthesis, where the tendon attaches to the heel. The strain on the Achilles tendon enthesis can put extra stress on the retrocalcaneal bursa and cause bursitis.
- Foot deformity – Bone abnormalities and other deformities increase the likelihood of developing Retrocalcaneal bursitis. For example, a Haglund deformity (a bony prominence at the back of the heel’s calcaneus) can cause extra friction between the Achilles tendon and the bursa, leading to retrocalcaneal bursitis.
You might also be more at risk for developing Retrocalcaneal bursitis if you:
- Are over the age of 65 years.
- Participate in high-contact sports (e.g. basketball / football).
- Do not stretch properly before exercising.
- Have tight muscles.
- Work in an area that requires repetitive movement and stress on the joints.
How Does it Affect You? How Serious is it?
Some serious complications that are associated with Retrocalcaneal bursitis include infections such as septic bursitis and the trauma that can occur at the back of the heel, as described below:
- Septic bursitis – Retrocalcaneal bursitis can be caused by an infection in the bursa. This condition is called septic bursitis. While anyone can develop septic bursitis, certain medical conditions, such as diabetes, alcoholism, and rheumatoid arthritis, can increase the risk. Medications that suppress the immune system may also increase the chances of developing this life-threatening infection.
- Trauma to the back of the heel – Striking the back of the heel against a hard object or other trauma can injure the bursa and lead to chronic bursitis. The injured bursa may become swollen with blood, synovial fluid, or even a combination of the two.
Recommended Treatment & Rehabilitation
If symptoms do not respond to home treatments, consultation with a doctor may be recommended. A diagnosis for retrocalcaneal bursitis will include the following:
- Patient interview – A doctor will ask about medical history, the onset of symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask a patient what type of shoes they wear and what they do for exercise.
- Physical exam – Your doctor will then examine your foot, noting swelling, tenderness, and pain points, and range of motion. The doctor may also ask you to point and flex the feet and stand on his or her toes.
If heel pain has not responded to certain treatments, or if the doctor wants to rule out another condition, medical imaging may be ordered. Examples of medical imaging tests include:
- Magnetic Resonance Imaging (MRI)
X-rays can show abnormalities of the heel’s calcaneal bone. Abnormalities, such as bone spurs or a Haglund deformity, can affect the heel’s biomechanics and increase the risk of retrocalcaneal bursitis. An MRI or diagnostic ultrasound may be ordered if a physician suspects or wants to rule out a problem with the Achilles tendon itself, such as tendonitis or a tear.
If septic heel bursitis is suspected, your doctor may remove fluid from the bursa with a needle and syringe. This procedure is called a bursal aspiration. It is an outpatient procedure done with a local anesthetic.
More than 90% of patients with Retrocalcaneal bursitis do not require surgery and are able to see significant improvement with physiotherapy alone. While physiotherapy cannot eliminate heel pain altogether, it can reduce inflammation that causes pain and impedes mobility.
An experienced physiotherapist will likely combine stretching, taping, massage, and lower leg strengthening exercises to create a heel pain recovery plan that is safe, effective, and well-designed to prevent further re-injury. Typically, a Retrocalcaneal bursitis physiotherapy plan will primarily focus on pain relief, then flexibility, range of motion, and muscle control, and finally a return to your regular activity.
Retrocalcaneal bursitis is treated by measures that decrease the associated inflammation and avoid re-injury. Local ice applications both reduce pain and inflammation. Anti-inflammatory medications, such as naproxen, ibuprofen, or injections of cortisone, are often helpful.
Additionally, orthotic devices or shoe inserts are used to take pressure off heel pain (a donut-shaped insert), and heel lifts can reduce stress on the Achilles tendon to relieve painful heel spurs at the back of the heel. Similarly, sports running shoes with soft, cushioned soles can be helpful in reducing irritation of inflamed tissues from Retrocalcaneal bursitis. Infrequently, surgery is performed on a chronically inflamed heel.
As for exercises for our feet, mobility, and strength are essential to keep us moving pain freely. The goal of these exercises is to strengthen the muscles in the feet and calves while improving flexibility in the Achilles tendon and plantar fascia. Here are some exercise examples you can try, including the following:
While in a standing position with the feet close together, place a tennis ball in between the heels and maintain the position of the ball by squeezing the heels together. Afterward, in a controlled motion, raise up on the toes and then return to your starting position. Complete this exercise 2 sets of 10 repetitions twice a day.
Standing calf stretch
Stand facing a wall and place your foot up against the wall. With your knee bent, lean forward until you feel a stretch in the calf closest to the wall and hold the position. Complete this stretch 2-3 times a day.
Standing gastroc stretch
Firstly, stand and place both hands on a wall. Secondly, place one leg behind the other, slightly staggered, and lean your body forward without bending the back knee until you feel a stretch in your back calf. Remember to keep the correct arch position in your foot and keep the heel on the ground. Finally, ensure both feet are facing upward before repeating the stretch 2 more times of up to 60-second holds twice a day.
Plantar fascia release
Sit in a chair to help control the pressure put on your feet. Then, take a lacrosse ball and place it under your affected foot. Apply downward pressure on the lacrosse ball with the foot. Next, stay off the heel and ball of the foot, keeping the ball inside the foot. Move the ball under your foot to find tender sports. Once you are on a tender spot, hold the position while applying pressure. Continue to massage for up to 30 seconds before repeating 2-3 times.
Alternative & Homeopathic Treatment
Here are some easy home remedies that can help provide a good degree of relief from pain linked to retrocalcaneal bursitis:
- Essential oils – Gently massage your heels with this treatment product. Pure essential oils like rosemary or lavender and ever everyday oils such as coconut and olive oil may help reduce pain due to their anti-inflammatory properties. Coconut oil also acts as a natural moisturizer that softens your heels. Just simply warm up the oil slightly and rub it deeply but gently into your affected heel.
- Supportive footwear – Try to wear shoes that provide good arch support and have a low heel, especially if you are going to be on your feet more often. This helps to support your plantar fascia and prevent them from becoming inflamed.
- Night splints – Night splints help to relieve heel pain by stretching your arches and calves overnight. These tend to work best for patients who also had plantar fasciitis for at least six months. Most are meant to be used for one to three months and come in both hard and soft models.
- Massage – You can perform simple massage techniques to soothe the pain in your heels. Use your thumbs to massage your arches and heels, working from the balls of your feet up to your heel. You may also use a golf ball to massage your arches. Put your foot on the golf ball, hang on to a stable item, and roll the golf ball under your arches.
- Ice application – While an ice cube can result in a good massage, an ice pack can also help reduce inflammation. Cover your ice pack with a cloth or thin towel and hold it over the painful area three to four times daily for 15-20 minutes at a time.
- Rest – Sometimes, mild heel pain is a sign that your feet simply need to rest, especially if you regularly do high-impact sports. Giving your feet a break for a few days can help reduce inflammation and let your plantar fascia heal. While you heal, try a low-impact activity, such as swimming.