A lesser known type of heel pain is a condition called Bursitis of the Heel. A bursa is a fluid-filled sac that cushions the muscles, tendons and bones in our joints. It helps keep them from rubbing
against each other and reduces friction in the areas around the joints. Bursitis is Latin for inflammation of the bursa. Repeated movement and pressure on the bursa can cause it to swell and become
inflamed. Trauma, infection or crystal deposits can also cause Bursitis. The joints that are usually affected by bursitis are the large joints such as the shoulder, hip and knee but in some cases
also the back of the heel.
Pain at the posterior heel or ankle is most commonly caused by pathology at either the posterior calcaneus (at the calcaneal insertion site of the Achilles tendon) or at its associated bursae. Two
bursae are located just superior to the insertion of the Achilles (calcaneal) tendon. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the Achilles
tendon and the calcaneus. Posterior or superficial to the Achilles tendon is the subcutaneous calcaneal bursa, also called the Achilles bursa. This bursa is located between the skin and posterior
aspect of the distal Achilles tendon. Inflammation of either or both of these bursa can cause pain at the posterior heel and ankle region.
Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. Pain is typically experienced during activities
requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially
whilst wearing excessively tight shoes). Often pain may be worse with rest after these activities (especially that night or the following morning). The pain associated with this condition may 'warm
up' with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases,
patients may walk with a limp or be unable to weight bear on the affected leg. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles
A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis. Diagnosis may be confirmed with an ultrasound investigation,
MRI or CT scan.
Non Surgical Treatment
Caregivers may give you special shoe inserts with a cutout around the tender area. You may also be told to wear shoes with a reinforced heel counter. This will give better heel control. You may need
other shoe inserts (wedges) to raise your heel so it does not press against the back of the shoe. You may also wear shoes that are open in the back, such as sandals that have no strap across the
heel. You may use ibuprofen (eye-bu-PROH-fen) and acetaminophen (a-seet-a-MIN-oh-fen) medicine for your pain. These may be bought over-the-counter at drug or grocery stores. Do not take ibuprofen if
you are allergic to aspirin. You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This
medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your ankle is healed and that you can return to heavy exercise. It is important to not
exercise until your caregiver says it is OK. You could make the bursitis worse if you exercise too soon. You may need surgery to remove the bursa or part of your ankle bone. Surgery is usually not
necessary unless the bursitis is very bad and does not heal with other treatments. Your caregiver may want you to go to physical (FIZ-i-kal) therapy (THER-ah-pee). Physical therapists may use
ultrasound to increase blood flow to the injured area. Caregivers may use massage to stretch the tissue and bring heat to the injury to increase blood flow. These and other treatments may help the
bursitis heal faster. Exercises to stretch your Achilles tendon and make it stronger will be started after the bursitis has healed. You may gradually increase the amount of weight you put on your
foot when caregivers say it is OK. You may be told to stop exercising if you feel any pain.
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help