Achilles bursitis is an inflammatory condition that affects the small, fluid-filled sacs, known as bursae, located near the heel bone and the Achilles tendon. These sacs normally provide a cushion, reducing friction during movement. Repeated trauma or excessive pressure can cause them to become irritated and swollen, leading to pain and tenderness at the back of the heel. Inflammation typically occurs in the retrocalcaneal bursa (between the tendon and the heel bone) or the posterior Achilles tendon bursa (between the tendon and the skin). Recovery involves a spectrum of treatments, starting with immediate self-care and progressing toward professional medical interventions for persistent cases.
Immediate Relief Through Self-Care
Initial management of Achilles bursitis centers on immediate symptom control and reducing the mechanical stress on the inflamed bursa. The RICE protocol—Rest, Ice, Compression, and Elevation—is the first line of defense against pain and swelling. Resting the affected ankle is paramount, requiring a temporary reduction in activities that aggravate the heel, such as running or excessive walking.
Applying a cold pack to the back of the heel for 15 to 20 minutes several times a day helps constrict blood vessels, mitigating local swelling and pain. Always use a thin cloth barrier to protect the skin from direct contact with the cold source. Light compression, such as wrapping the ankle with an elastic bandage, helps control fluid accumulation. Ensure the wrap is not so tight that it causes numbness or tingling.
Elevating the foot above the heart uses gravity to promote fluid drainage, contributing to reduced swelling. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, alleviate both pain and the underlying inflammatory process. Modifying footwear is also important, which involves avoiding stiff-backed shoes, high heels, or any footwear that places direct, irritating pressure on the rear of the heel.
When to Seek Professional Medical Care
While self-care is often sufficient to resolve bursitis, certain signs indicate the need for a professional medical evaluation. If the pain and inflammation fail to improve after one to two weeks of consistent at-home treatment, consultation with a healthcare provider is warranted.
Immediate medical attention is necessary if signs of infection are present, including a fever, pronounced warmth radiating from the heel, excessive redness, or the presence of pus. The inability to bear weight on the affected foot, or the onset of sudden, sharp, or shooting pain, are also red flags that should prompt an urgent doctor’s visit.
Clinical and Invasive Treatment Methods
If conservative self-care measures prove ineffective, a healthcare professional can introduce more targeted treatments. Physical therapy is a common prescription, focusing on a structured program of stretching and strengthening exercises for the calf muscles and Achilles tendon complex. Improving tendon flexibility helps reduce the mechanical friction that irritates the bursa.
Custom orthotics or simple heel lifts are often recommended to subtly alter foot mechanics, which can decrease strain on the tendon and reduce pressure on the inflamed bursa. If symptoms remain severe, a corticosteroid injection may be administered directly into the bursa to rapidly decrease inflammation.
This injection procedure carries a specific risk of compromising the integrity of the adjacent Achilles tendon, potentially leading to weakening or rupture. Therefore, the injection must be performed with precision, often using ultrasound guidance, and is typically limited to one or two doses separated by several months. Another minimally invasive option is aspiration, where a needle is used to drain the excess fluid from the bursa, providing immediate pressure relief.
Surgical intervention, known as a bursectomy, is reserved as a last resort for chronic cases of Achilles bursitis that have not responded to months of non-surgical treatment. This procedure involves the surgical removal of the inflamed bursa. It may be performed along with the removal of any bony prominence, such as a Haglund’s deformity, that is contributing to the irritation.