Retrocalcaneal bursitis is a specific cause of pain at the back of the heel, often mistakenly identified as a more common issue like Achilles tendonitis or plantar fasciitis. This condition develops when a small, fluid-filled sac located near the heel bone becomes inflamed. Understanding the location and function of this structure clarifies the source of discomfort. Recognizing this issue is the first step toward effective treatment and a return to comfortable movement.
What Is the Retrocalcaneal Bursa?
A bursa is a thin, slippery sac filled with synovial fluid, found near joints throughout the body. The primary role of these sacs is to act as a cushion and lubricant, reducing friction between bone and soft tissues like tendons, muscles, or skin. This cushioning allows for smooth movement, particularly where tendons glide over bony prominences.
The retrocalcaneal bursa is positioned deep in the heel, situated between the calcaneus (heel bone) and the large Achilles tendon. The bursa facilitates the gliding motion of the Achilles tendon over the heel bone when the foot and ankle move. Retrocalcaneal bursitis occurs when this sac becomes irritated and inflamed, leading to swelling and pain at the back of the heel.
Triggers and Risk Factors
The most common cause of retrocalcaneal bursitis is repetitive mechanical stress or overuse on the heel and ankle area. Activities involving frequent and forceful heel strikes, such as running, jumping, or excessive walking, can lead to chronic irritation of the bursa. A rapid increase in the intensity or duration of a physical activity regimen without proper conditioning can also initiate inflammation.
The type of footwear worn is another factor contributing to this condition. Shoes that are too tight, have a rigid back, or a restrictive heel counter can cause excessive pressure and friction against the back of the heel, directly irritating the bursa. Individuals with tight calf muscles are also at a higher risk, as this tension increases the strain placed on the Achilles tendon, which compresses the bursa. Underlying medical conditions, including inflammatory disorders like rheumatoid arthritis or gout, can also predispose an individual to retrocalcaneal bursitis.
Identifying the Signs and Symptoms
The main symptom of retrocalcaneal bursitis is localized pain at the back of the heel, specifically just above the insertion of the Achilles tendon. This discomfort is often described as a constant ache that worsens with activity like walking or running. The pain is aggravated by applying direct pressure to the area, such as when wearing rigid shoes.
Visible signs of inflammation may include swelling, redness, and warmth to the touch on the back of the heel. The pain often intensifies when trying to stand on tiptoes or when the ankle is flexed, a motion that compresses the inflamed bursa. This condition is distinct from plantar fasciitis, where the pain is primarily felt on the underside of the heel and is most severe during the first steps taken in the morning.
Treatment and Recovery Strategies
Initial management focuses on reducing inflammation and pain through conservative self-care methods. Rest is important to avoid the repetitive movements that caused the irritation. Applying ice to the affected area several times a day helps alleviate swelling. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be used to manage pain and reduce the inflammatory response.
Footwear modifications are a cornerstone of long-term recovery and prevention. Wearing shoes with a soft, open, or slightly elevated heel helps reduce pressure and friction on the bursa. Healthcare providers may also recommend physical therapy, which includes gentle stretching exercises targeting the Achilles tendon and calf muscles. Improved flexibility in these structures decreases the tension and strain placed on the bursa.
If conservative measures do not provide relief, a doctor may suggest more advanced interventions. A corticosteroid injection, often mixed with a local anesthetic, can be administered directly into the inflamed bursa to provide powerful anti-inflammatory effects and rapid pain relief. This procedure is approached with caution due to the risk of weakening the adjacent Achilles tendon.
Custom orthotic devices or heel lifts can be used to correct abnormal foot mechanics and redistribute pressure evenly across the foot. In rare cases where the condition is chronic and does not respond to a minimum of six months of conservative treatment, a surgical procedure called a bursectomy may be considered. This involves the removal of the inflamed bursa, allowing the body to regenerate a new, healthy one over time.