According to a North West Adelaide health study, approximately 3.6% of Australians over the age of 18 will experience heel pain.[1] Those who participate in skating sports, such as ice skating or rollerblading are particularly at risk and have up to a 34% chance of developing this condition.[2]
While retrocalcaneal bursitis is the most common type of ‘heel bursitis’, it is not the only one. Subcutaneous calcaneal bursa (or Pre-Achilles bursa) is a similar condition which also causes heel pain. The original purpose of these bursae is to act as a lubricant to protect the Achilles tendon from sliding on top of the calcaneus (heel bone).
Read on to understand what you should know about retrocalcaneal bursitis; the risk factors, treatment options and expected recovery time.
What is Retrocalcaneal Bursitis?
Retrocalcaneal bursitis (also known as Achilles tendon bursitis or heel bursitis) is a painful condition at the back of the heel. Inflammation will occur along the Achilles bursa, which is a fluid-filled sac found between the Achilles tendon and calcaneus (heel bone).
So what is a bursa?
A bursa is a fluid-filled sac that serves as a cushion to minimise the friction between the bone and other soft tissues. Excessive stress on the heel and Achilles can result in irritation on the heel bursa resulting in pain and swelling.
What are the symptoms of retrocalcaneal bursitis?
The primary symptoms of retrocalcaneal bursitis include stiffness and a lack of movement in the foot, calf pain and heel swelling. People may also experience a "cracking" sound with foot movement, as well as redness surrounding the heel.
Common symptoms of retrocalcaneal bursitis
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Pain at the back of the heel or ball of foot pain
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Pain when running uphill
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Pain that gets worse when standing on tiptoes
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Swelling and tenderness
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Increased pain when contracting the calf muscle
What causes retrocalcaneal bursitis?
The primary cause of retrocalcaneal bursitis is overuse of the heel in activities. This most commonly occurs in sporting individuals or people who have rapidly increased the amount of exercise they are doing on a regular basis.
Common causes of retrocalcaneal bursitis
Sports that increase the risk of retrocalcaneal bursitis
Sports activities that cause excessive pressure on the back of the heel and repetitive trauma around the achilles increases your chance of having retrocalcaneal bursitis.
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Basketball
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Long-distance running
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Trekking
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Ballet
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Tennis
How is retrocalcaneal bursitis diagnosed?
Having retrocalcaneal bursitis can have a significant impact on your daily activities. Simple walking to work or a morning jog can be painful and may worsen as the condition progresses.
There are several options available when it comes to diagnosing your heel pain as retrocalcaneal bursitis. One of the most common and most recommended by Australian GPs is an assessment from a physiotherapist.
Physiotherapists are the go-to medical professionals when it comes to pain and injury. They are qualified to screen and diagnose musculoskeletal injuries such as retrocalcaneal bursitis.
Your evaluation will start with a consultation. It is similar to having a mini-interview. Your physiotherapist will ask you related questions about your injury and medical history. Use this time to discuss all of your symptoms and health concerns relating to your injury.
After taking your medical history, your physiotherapist will perform a physical assessment of your foot and lower extremities to check for factors that may cause your condition.
Your physiotherapist will then create a specific treatment plan for you and will guide you through your recovery.
This will also include:
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Exercise program at home
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Detailed treatment program
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Strategies and techniques to deal with pain
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Expert advice on how you can regain your full function.
How is retrocalcaneal bursitis treated?
Retrocalcaneal bursitis can be frustrating and limit your mobility. Although it can lead to severe inflammation of the bursa and irritation of the tendons, it is highly possible to treat it conservatively.
There are several options when it comes to treating retrocalcaneal bursitis. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
Physiotherapists routinely treat patients with retrocalcaneal bursitis. They are in the best position to give quality care and treatment for your injury to help you regain normal function as soon as possible.
Your treatment will focus on decreasing your pain and inflammation in the early stages. This will be followed by strengthening and correcting your mechanics to prevent reinjury and improve the quality of your life.
Depending on the severity of your retrocalcaneal bursitis, a physiotherapist may provide you with a combination of the following types of treatments:
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Manual Therapy - Hands-on therapy to increase blood flow and joint mobility of the foot.
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Cryotherapy - The application of cold therapies can control signs of inflammation.
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Ultrasound Treatment - Ultrasound waves accelerate soft tissue healing on the areas of your foot.
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Stretching Exercises - Gentle stretching exercises help relieve muscle tension and prevent stiffness of the Achilles tendon and calf muscle.
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Therapeutic Exercises - Exercise techniques to correct impairments and support your recovery.
A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.
Next step - Creating a treatment plan made for you
Your physiotherapist will then create a detailed treatment program based on your lifestyle and assessment to help you maximise your recovery.
Self-care for retrocalcaneal bursitis
If you think you have retrocalcaneal bursitis, here are the best things you can do and avoid.
Things to do:
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Rest
Take a break from your activities for a few days until the inflammation subsides. Prolonged walking, running, or activities like climbing stairs can further irritate the bursa.
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Ice
Apply ice to the inflamed areas of your heel to decrease pain and manage the swelling.
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Stretching of your foot:
Gently stretch the muscles and tendons of your foot and calves to relieve tension.
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Shoe inserts and padding
You can use heel cups or padding for the back of your heel to decrease discomfort and pressure when wearing shoes.
Things to avoid:
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Wearing high-heeled shoes puts the achilles in a shortened position which may irritate the bursa further.
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Avoid high impact activities.
Take a break from sports for up to a few days or until the inflammation subsides to allow your body to recover properly.
Do I need a specialist or surgery?
Physical assessments are usually enough to make a conclusive diagnosis of retrocalcaneal bursitis. However, diagnostic imaging may be done to confirm and rule out other possible conditions that affect you.
Doctors may also prescribe corticosteroid injections to manage the pain and inflammation.
Although rarely done, surgery may offer a solution if the condition is unresponsive to treatment by removing the bursa itself.
Physiotherapists can maximise your recovery and provide you with treatment that can help you recover from retrocalcaneal bursitis.
What is the recovery time / prognosis for retrocalcaneal bursitis?
Ultimately, recovery time is dependent on being proactive and seeking professional treatment along with the severity of your foot pain and injury.
You can make a full recovery from retrocalcaneal bursitis within two to eight weeks. A combination of resting and low impact activities is the key to treating your pain.
Physiotherapy can accelerate your healing time, allowing you to get back to your normal activities faster.
Important factors in recovery include:
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Sticking to your treatment program and regularly exercising
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Resuming your sports activity gradually
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Paying attention to pain, and resting as necessary.
Can retrocalcaneal bursitis be prevented?
The advice below will help you prevent retrocalcaneal bursitis or help you recover if you already have it.
Stretch your lower body muscles, especially the calf and Achilles tendon, to reduce the tension on the muscles.
- Wear slippers or open footwear
Wearing slippers eliminates the pressure on the back of the heel when you walk.
- Apply ice on your foot after intense activities
Applying ice after intense running activities and high-impact sports can help manage or prevent inflammation on the heel.
Wearing athletic shoes with a proper cushion prevents foot injury and pain.
Outlook and the main takeaways
Retrocalcaneal bursitis can result from sports activities and the frequent use of poor-fitting and high-heeled shoes. It is vital to catch the early warning signs of heel bursitis before they worsen and affect your routine.
If you are having heel pain or experiencing symptoms of retrocalcaneal bursitis, book a consultation with a physiotherapist to start your road to recovery immediately.
Anatomy of the heel bursa
A bursa appears in between the junction of a tendon and bone. It is filled with fluid that acts as a cushion to allow soft tissue to glide smoothly with minimal friction on bone.
The retrocalcaneal bursa is located on the top of the rear aspect of your heel bone just under the Achilles tendon. These structures are biomechanically close enough to each other and thereby predisposed to irritation of the bursa and tendon.
