This is a very common condition that leads to foot pain . Once you understand what it actually is you will wonder why it does not occur more often, particularly in the foot. It is an inflamed bursal
sac. A bursal sac is a sac filled with fluid that acts to lubricate and reduce the friction between two surfaces in the body, usually muscles and tendons as they glide over bony prominences, however
their purpose in not limited to just muscles and tendons. The body contains literally hundreds of bursal sacs but in the foot there is just one naturally occurring (adventitious) bursal sac. It is
located between the Achilles tendon and the heel bone (calcaneaus), otherwise known as an achilles tendon bursal sac.In this instance the Achilles tendon is protected from the pressure of the heel
bone pressing against it when we walk.
A rapid increase in physical activity levels or thinning of the heel?s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible causes of infracalcaneal bursitis
include blunt force trauma, acute or chronic infection, and arthritic conditions. The following factors may increase your risk of experiencing bursitis, including infracalcaneal bursitis.
Participating in contact sports. Having a previous history of bursitis in any joint. Poor conditioning. Exposure to cold weather. Heel striking when running, especially in conventional running shoes
with heel elevation.
When the bursa becomes inflamed after an injury, symptoms usually develop suddenly. When the bursa develops without an injury, symptoms may develop gradually. With both posterior and anterior
Achilles tendon bursitis, symptoms usually include swelling and warmth at the back of the heel. A minimally red, swollen, tender spot develops on the back of the heel. When the inflamed bursa
enlarges, it appears as a red lump under the skin of the heel and causes pain at and above the heel. If posterior Achilles tendon bursitis becomes chronic, the swelling may become hard, fluid-filled,
and red or flesh-colored.
Your health care provider will take a history to find out if you have symptoms of retrocalcaneal bursitis. Examining your ankle can find the location of the pain. The physician will look for
tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex). Or, the pain may be worse when you rise on your toes. You will not usually
need imaging studies such as x-ray and MRI at first. If the first treatment does not improve the symptoms, your health care provider may recommend these tests. MRI may show inflammation.
Non Surgical Treatment
In addition to R.I.C.E., there are a number of other treatments to reduce swelling and any associated pain or discomfort due to heel bursitis. Orthotics or change of footwear. Wearing an orthotic
device such as a heel insert can encourage better mechanics in the foot and reduce irritation of the retrocalcaneal bursa. Some people do not need special orthotics but simply need to stop wearing
shoes with rigid heel and ankle construction and instead wear more supportive, comfortable shoes. Shoes with an "Achilles notch," a groove in the collar at the back of the shoe to protect the
Achilles tendon, can be particularly helpful. (Almost all running shoes are designed with an Achilles notch.) Stretching and physical therapy. Stretching the Achilles tendon often helps alleviate
pain. Once the pain is resolved it is important for the patient to continue a regular stretching program. Regular stretching reduces the chance of recurrence.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be
effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat
another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any
bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around
the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis
symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.
You can avoid the situation all together if you stop activity as soon as you see, and feel, the signs. Many runners attempt to push through pain, but ignoring symptoms only leads to more problems.
It?s better to take some time off right away than to end up taking far more time off later. Runners aren?t the only ones at risk. The condition can happen to any type of athlete of any age. For all
you women out there who love to wear high-heels-you?re at a greater risk as well. Plus, anyone whose shoes are too tight can end up with calcaneal bursitis, so make sure your footwear fits. If the
outside of your heel and ankle hurts, calcaneal bursitis could be to blame. Get it checked out.