Heel pain is a common concern that can affect daily activities. Many factors contribute to heel discomfort, making identification challenging. Heel bursitis is one potential cause. This article explores its nature, common triggers, signs, and management strategies.
What is Heel Bursitis?
Bursae are small, fluid-filled sacs that reduce friction between bones, tendons, and muscles. When one becomes irritated and inflamed, it’s called bursitis. Heel bursitis specifically involves inflammation of bursae near the heel bone.
The heel area contains two primary bursae that can be affected. The retrocalcaneal bursa is deeper, between the Achilles tendon and the heel bone (calcaneus), reducing friction as the tendon moves. The superficial calcaneal bursa is between the skin and the Achilles tendon at the back of the heel. Both types can cause pain and swelling.
Causes and Contributing Factors
Heel bursitis often develops from repeated overuse or sustained stress on the heel. Activities like frequent running or jumping can irritate the bursae. A sudden increase in physical activity without proper conditioning can also place excessive strain on the heel.
Improper footwear is a common contributor. Shoes that are too tight, lack adequate support, or have a stiff heel counter can put pressure on the back of the heel, leading to irritation. Biomechanical issues, such as high arches or flat feet, may alter gait and increase stress on the heel. A tight Achilles tendon can also contribute by increasing pressure on the bursa.
Identifying the Signs
The primary indicator of heel bursitis is pain and tenderness at the back of the heel. This discomfort may worsen with activities like walking, running, or standing on tiptoes. The affected area can also exhibit visible swelling, redness, or warmth.
Stiffness or a limited range of motion in the ankle, especially after periods of rest, can be present. A hard, red bump may develop at the back of the heel, particularly with superficial calcaneal bursitis.
Diagnosis and Management
Diagnosing heel bursitis typically begins with a physical examination. This involves assessing the heel for tenderness, swelling, and evaluating the ankle’s range of motion. Imaging tests, such as X-rays, might rule out other bone-related issues, while an MRI can provide detailed views of soft tissues.
Management of heel bursitis focuses on non-surgical approaches. Rest reduces stress on the inflamed bursa. Applying ice to the affected area decreases pain and swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) manage discomfort and inflammation.
Stretching exercises, particularly for the Achilles tendon, improve flexibility and reduce tension. Physical therapy provides a structured program for rehabilitation, focusing on strengthening and stretching. Modifying footwear by choosing supportive shoes with adequate cushioning and avoiding those that rub or press on the heel is important. Heel pads or orthotics may redistribute pressure. In persistent cases, steroid injections may be considered, but surgery to remove the bursa is rarely needed and usually reserved for unresponsive cases.