Bursitis is the inflammation of a bursa. Retrocalcaneal bursitis is in inflammation of the bursa located between the calcaneus and the anterior surface of the Achilles tendon.There are two bursae
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. It is also known as Achille tendon bursitis. It can often be mistaken for
Achilles tendonitis or can also occur in conjunction with Achilles tendonitis.
Bursitis can be caused by an injury, an infection, or a pre-existing condition in which crystals can form in the bursa. Injury. An injury can irritate the tissue inside the bursa and cause
inflammation. Doctors say that bursitis caused by an injury usually takes time to develop. The joints, tendons, or muscles that are near the bursae may have been overused. Most commonly, injury is
caused by repetitive movements.
Symptoms of Achilles bursitis are often mistaken for Achilles tendinitis because of the location of the pain at the back of the heel. When you suffer from Achilles bursitis you will experience some
or all of the following symptoms which are most noticeable when you begin activity after resting. High heels can add pressure on the retrocalcaneal bursa, subcutaneous calcaneal bursa, and Achilles
When a patient has pain in a joint, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x-rays,
although sometimes there are also calcium deposits in the joint that can be seen. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination
can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, and crystals, which could indicate gout.
In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the
Non Surgical Treatment
Many cases of retrocalcaneal bursitis can be resolved with self-care that is focused on reducing inflammation and eliminating activities or positions that aggravate the bursa. Some cases, however,
may become more serious and require more medical interventions. Rarely, surgery is needed. Following the R.I.C.E. formula, or Rest, Ice, Compression, and Elevation, is often sufficient to treat
aseptic bursitis. Rest. People with retrocalcaneal bursitis should avoid activities that irritate the bursa, such as jogging or excessive walking. Ice. Applying a cold compress to the back of the
ankle for about 20 minutes two or three times a day may help alleviate symptoms and decrease swelling. Compression. An elastic medical bandage (e.g. Ace? bandage) wrapped around the affected heel and
ankle can help control swelling. Elevating the affected heel. Sitting down with the leg elevated on a stool or lying down with the foot elevated on a pillow can help reduce blood flow to the area,
thereby reducing inflammation.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be
effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat
another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any
bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around
the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis
symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.