Achilles bursitis is a painful condition affecting the back of the heel. A bursa is a small, fluid-filled sac found throughout the body, acting as a cushion between bones, tendons, and muscles to reduce friction during movement. When this sac becomes irritated or inflamed, the condition is known as bursitis. Achilles bursitis specifically involves the inflammation of one of the two bursae located near the Achilles tendon, which connects the calf muscles to the heel bone. This inflammation leads to localized pain and swelling that can significantly interfere with walking, running, and wearing certain types of shoes.
Understanding the Different Types of Achilles Bursitis
The inflammation at the back of the heel can occur in two distinct locations, leading to two types of Achilles bursitis. The first, and often more common type, is Retrocalcaneal Bursitis, situated deep between the Achilles tendon and the heel bone (calcaneus). Its function is to provide friction-free movement where the tendon glides over the bony prominence.
The second type is Superficial Calcaneal Bursitis, located superficially between the skin and the back of the Achilles tendon. Because of its position, this type is frequently irritated by external forces.
The superficial type often results from repetitive rubbing or pressure from footwear, sometimes causing a tender nodule to form. The deep, retrocalcaneal bursa is more commonly irritated by biomechanical stresses and overuse that increase compression between the tendon and the bone.
Primary Causes and Risk Factors
Achilles bursitis is frequently triggered by mechanical stress and underlying anatomical factors. The most common cause is chronic overuse or acute strain on the bursa, particularly from repetitive activities like running, jumping, or extensive walking. A sudden increase in the intensity or duration of physical training without adequate conditioning can quickly lead to irritation.
Footwear plays a significant role in the development of both types of bursitis. Ill-fitting, stiff shoes or those featuring a rigid back (heel counter) create excessive pressure or friction against the heel. This constant rubbing can directly cause inflammation of the superficial bursa, while flat heels increase tension on the Achilles tendon, increasing compression on the retrocalcaneal bursa.
Certain structural and health conditions also increase the risk. An enlarged bony prominence on the back of the heel, known as a Haglund deformity or “pump bump,” can cause impingement on the bursa during ankle movements. Systemic inflammatory conditions like gout or rheumatoid arthritis can also cause the bursa to become inflamed.
Recognizing the Symptoms
The hallmark symptom of Achilles bursitis is pain and tenderness at the back of the heel. This discomfort is most noticeable when walking, running, or when the area is directly pressed. The pain tends to worsen with activities that require pushing off the toes, such as walking uphill or standing on tiptoes.
Visible signs of inflammation are typical, including localized swelling that may appear as a soft, tender bump. The skin over the inflamed bursa may feel warm and appear red. Swelling from the superficial type is easily seen just under the skin, while the deep type causes more diffuse swelling around the tendon insertion.
Wearing closed-back shoes often becomes difficult and painful, as the pressure irritates the swollen bursa. Patients may also experience stiffness or a limited range of motion in the ankle joint. These symptoms can mimic other heel conditions, such as Achilles tendonitis, making professional evaluation important.
Diagnosis and Management Strategies
A medical professional typically diagnoses Achilles bursitis through a physical examination and a review of symptoms and activity history. During the exam, the doctor looks for tenderness, swelling, and warmth, often applying pressure between the tendon and the heel bone to pinpoint the pain. Imaging tests are not always necessary but may be used to rule out other issues.
X-rays can help identify bony abnormalities, such as a Haglund deformity or heel spurs, that might be contributing to the irritation. Magnetic Resonance Imaging (MRI) or ultrasound may be used if the condition is persistent or if there is concern about concurrent Achilles tendon damage. These scans provide clear images of the soft tissues, confirming bursa inflammation.
Initial management is conservative, focusing on reducing inflammation and pressure. Rest is foundational, requiring the patient to stop or significantly decrease activities that aggravate the pain. Applying ice to the affected area several times a day helps to reduce swelling and discomfort. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to manage pain and decrease inflammation.
Modifying footwear is a crucial step in the treatment plan. Wearing open-backed shoes or using protective padding can eliminate friction on the back of the heel. Physical therapy, including stretching and strengthening exercises for the calf muscles, may be recommended to reduce tension on the Achilles tendon and alleviate pressure on the deep bursa. Corticosteroid injections are sometimes considered for persistent inflammation but must be administered with extreme caution near the Achilles tendon to avoid weakening the tendon structure. Surgery is a rare option, reserved only for cases where conservative treatments have failed to provide relief after several months, often involving the removal of the inflamed bursa or the bony prominence.