Bursae (two or more bursa) are small, fluid-filled sacs that cushion the bones, tendons and muscles surrounding your joints. They contain a lubricating fluid that reduces friction, allowing tissues in the body to glide past each other smoothly. Imagine the bursa as a protective layer that helps keep a tendon or muscle from fraying or getting aggravated as it eases over a bone or around a corner. Bursitis is a condition that occurs when a bursa becomes inflamed: irritated, red and filled with more fluid than normal.
There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.
Unlike Achilles tendinitis, which tends to manifest itself slightly higher on the lower leg, Achilles tendon bursitis usually creates pain and irritation at the back of the heel. Possible signs of bursitis of the Achilles tendon include difficulty to rise on toes. Standing on your toes or wearing high heels may increase the heel pain. Inflammation and tenderness. The skin around your heel can become swollen and warm to the touch. Redness may be visible. Pain in the heel. Pain tends to become more prominent when walking, running, or touching the inflamed area. Stiffness. The back of your ankle may feel a little stiff due to the swelling of the bursa.
After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including whether your pain is worse at specific times of the day or after specific activities. Any recent injury to the area. Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg. Your age and occupation. Your recreational activities, including sports and exercise programs. The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair.
Non Surgical Treatment
According to the National Institutes of Health, custom heel wedges can be purchased by people suffering from retrocalcaneal bursitis. These wedges reduce stress on the heel, which can reduce the pain and inflammation associated with an inflamed bursa. They can be purchased without a prescription, making it easy for anyone experiencing a flare-up of symptoms to get the added support of these wedges.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.