Heel bursitis is a painful condition occurring when the bursa—a small, fluid-filled sac near the heel bone—becomes irritated and inflamed. Bursae act as cushions and lubricants, protecting bones from friction caused by tendons and muscles. This guide explores the various approaches to managing this discomfort, from acute self-care to specialized medical interventions and long-term strategies. Successfully treating heel bursitis requires a structured approach that addresses both immediate pain and underlying mechanical issues.
Immediate Steps for Pain Relief
The initial response to heel bursitis focuses on reducing inflammation and easing acute pain, primarily through activity modification and the R.I.C.E. protocol. Rest is necessary, requiring you to temporarily stop activities that worsen the pain, such as running or prolonged standing, allowing the bursa time to heal. Applying a cold compress to the affected area for up to 20 minutes, three to four times a day, helps decrease swelling and localized warmth.
Compression and elevation manage fluid accumulation contributing to swelling. Elevating the foot above heart level encourages excess fluid circulation away from the heel. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken to reduce both pain and inflammation. Use these medications at the lowest effective dose for the shortest duration necessary, following label directions.
Adjusting footwear provides immediate relief by removing pressure from the inflamed bursa. Avoid shoes with a stiff or tight heel cup, which can rub against the back of the heel and cause further irritation. Switching to open-backed shoes or those designed with an “Achilles notch” can reduce friction on the area. This combination of self-care is often sufficient for mild cases to show improvement within a few weeks.
Professional Diagnosis and Non-Surgical Interventions
If home care measures do not provide relief within a couple of weeks, or if the pain is severe, seeking a professional medical evaluation is necessary. A healthcare provider will perform a physical exam, checking for tenderness, swelling, and range of motion. Imaging tests are often used to confirm the diagnosis and rule out other causes of heel pain, such as a stress fracture or Achilles tendinitis. An X-ray can show bone abnormalities, while an ultrasound or MRI can visualize the bursa and surrounding soft tissues.
A common non-surgical intervention is physical therapy, which focuses on restoring proper biomechanics and flexibility. Targeted exercises for stretching the calf muscles and the Achilles tendon are effective, as tightness in these areas increases tension on the heel bursa. Improving strength and flexibility helps redistribute pressure and reduce irritation, addressing the mechanical factors contributing to the bursitis.
Corticosteroid injections may be recommended if inflammation persists despite conservative measures. This procedure involves injecting anti-inflammatory medication directly into the bursa to decrease swelling and pain. Injections near the Achilles tendon are done with caution due to the risk of tendon degeneration or rupture. If the bursa is swollen with fluid, aspiration may be performed to drain the excess fluid, immediately relieving pressure. Specialized orthotic devices or heel wedges can also be prescribed to correct foot mechanics and reduce chronic irritation.
When Surgery is Necessary
Surgical intervention, typically a procedure called a bursectomy, is considered only as a last option for heel bursitis. This step is reserved for chronic cases where severe pain and inflammation have persisted for six to twelve months despite the failure of all conservative treatments. The goal of a bursectomy is the removal of the inflamed bursa sac.
The procedure may involve an arthroscope, used to remove the bursa through minimal incisions, or a mini-open technique. The surgeon may also remove any bony prominence, such as a Haglund’s deformity, that contributes to chronic irritation. Following surgery, a period of immobilization is often required, followed by a gradual return to weight-bearing activities. Full recovery takes several weeks, and physical therapy is resumed to restore strength and mobility.
Long-Term Prevention Strategies
Preventing the recurrence of heel bursitis centers on long-term mechanical and lifestyle adjustments. Selecting appropriate footwear is key, especially for individuals engaging in activities like running or prolonged standing. Choosing shoes with adequate cushioning, arch support, and a properly fitted heel counter helps absorb shock and distribute weight evenly.
Regular stretching routines maintain flexibility in the lower leg. Focusing on the calf muscles and Achilles tendon helps reduce the tension that can pull on the bursa and lead to inflammation. Consistency in these exercises is important for long-term reduction of mechanical strain on the heel.
Maintaining a healthy body weight is an effective preventative measure, as excess weight increases the load and stress placed on the heels. Avoiding sudden increases in the intensity or duration of physical activity gives the body’s tissues time to adapt. A gradual progression in training volume can prevent the overuse and repetitive stress injuries that often trigger bursitis flare-ups.