An inflammation of the bursa at the back of the heel bone (calcaneus) that causes pain with up-and-down movements of the foot.

Causes, incidence, and risk factors

A bursa is a fluid filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel where the large Achilles tendon (the tendon that connects the calf muscles to the heel) inserts on the calcaneus or heel bone. Repetitive or over use of the ankle, for instance by doing excessive waking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis . Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.

Signs and tests

Your doctor will take a history to find out if you have the above listed symptoms of retrocalcaneal bursitis. By examining your ankle they can generally tell the location of the pain and they will look for tenderness and redness in the back of the heel. Imaging studies such as X-ray and MRI are not usually necessary at first. If initial treatment fails to improve the symptoms, these studies may be obtained.

Treatment

The initial treatment for retrocalcaneal bursitis is avoidance of activities that cause pain and non-steroidal anti-inflammatory medications. Your doctor may recommend icing the heel several times a day and they may prescribe physical therapy to improve flexibility and strength around the ankle. Physical therapy serves two functions, it can help the bursitis improve and it can help prevent future recurrences. If these interventions are ineffective, then some health care providers may inject a small amount of steroids into the bursa. If the condition is associated with Achilles tendonitis , then casting the ankle to prevent motion for several weeks can be effective. Very rarely surgery may be indicated to excise the inflamed bursa.

Expectations (prognosis)

This condition has an excellent prognosis and usually resolves in several weeks once proper treatment is initiated.

Complications

Complications are uncommon. If the bursitis is associated with a tendonitis then tendon rupture is a possible complication. Steroid injections have also been associated with tendon rupture, especially if done too frequently.

Calling your health care provider

If you have heel pain or symptoms of retrocalcaneal bursitis and these symptoms do not improve with rest, contact your health care provider for proper evaluation and treatment.

Prevention

Maintaining proper form when exercising and good flexibility and strength around the ankle will help prevent this condition from arising.