Retrocalcaneal bursitis is a painful inflammation of the soft tissues at the attachment of the Achilles tendon to the back of the heel bone. The retrocalcaneus identifies the ?retro? or behind and
?calcaneus? or heel bone. Bursitis relates to inflammation of a bursa in the retrocalcaneal region. A bursa anatomically is a fluid filled sack that is located around tendinous attachments in the
body. The retrocalcaneal bursa as identified in the photo 1 protects the Achilles tendon just prior to its insertion to the retrocalcaneal region. The retrocalcaneal bursa cushions the Achilles
tendon and normally allows pain free motion of the Achilles tendon over the calcaneus.
The most common causes of bursitis are injury or overuse, although infection may also be a cause. Bursitis is also associated with other causes, such as arthritis, gout, tendinitis, diabetes, and
Below is a list of common signs and symptoms of retrocalcaneal bursitis. Recognizing and treating symptoms early can prevent retrocalcaneal bursitis from becoming chronic. Swelling. The
retrocalcaneal bursa is located behind the Achilles tendon, just above where the tendon attaches to the heel bone. When the bursa is inflamed it will cause visible soft tissue swelling near the top
of the heel bone. It is worth noting that bursitis of the retroachilles bursa, which is located between the Achilles tendon and skin, can manifest slightly differently: swelling may be more distinct,
appearing as a hard lump behind the heel. Retroachilles bursitis is also more likely than retrocalcaneal bursitis to cause the skin at the back of the heel to turn red.
Carrying out a diagnosis for bursitis is fairly straightforward. The doctor will examine the affected area and ask the patient some questions about his/her recent activities. If the patient has a
high temperature the physician may take a small sample of fluid from a bursa near the affected body part. The sample will be tested for bacteria, and perhaps also crystals. If the patient does not
get better after treatment the doctor may carry out further tests so that he/she can eliminate the possibility that the symptoms might not be due to something else. These may include an x-ray, to
make sure no bones are broken or fractured. Blood tests, to check for rheumatoid arthritis. A CT scan or MRI scan to see if there is a torn tendon.
Non Surgical Treatment
In addition to being aware of foot-wear and inserts, be sure to modify your activity level to reduce the pain initially. Taking non-steroidal anti-inflammatory drugs (NSAIDs) and icing twice a day
for 20 minute periods can help reduce the swell that leads to heel pain. Cortisone injections (more powerful anti-inflammatory medications) can be considered if your symptoms are persistent. After
the swelling and pain has receded, ask your podiatrist about working with a physical therapist to strengthen the affected area in order to avoid bursitis by using your muscles in a more safe and
efficient manner. If all these treatment methods fail, surgery may be the best option to excise a painful bursa (note that this is in rare cases).
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.