In your heel, there is a sac filled with fluid known as a bursa. It is located under your Achilles tendon at the back of your heel bone. Many of your large joints have a bursa around them. They
provide cushioning and lubrication for the tendons, muscles and bone. Bursitis of the heel occurs when the bursa in your ankle becomes swollen.
If the posterior-superior portion of the heel has an abnormally large bony prominence protruding from it (called a Haglund's Deformity), in some instances it may rub against the Achilles Tendon. When
this occurs, the bursa between the bone and the tendon will become inflamed, swollen, and painful. This condition is called Retrocalcaneal Bursitis. The presence of a Haglund's Deformity does not
insure that these problems will occur. In order for these problems to occur, the heel and foot must be tilted in such a way as to actually force this bony prominence into the bursa and tendon.
Retrocalcaneal bursitis is very similar to Achilles bursitis as the bursae are very close in proximity and symptoms are almost identical however retrocalcaneal bursitis is a lot more common. The
symptoms of bursitis vary depending on whether the bursitis is the result of injury or an underlying health condition or from infection. From normal overuse and injury the pain is normally a constant
dull ache or burning pain at the back of the heel that is aggravated by any touch, pressure like tight shoes or movement of the joint. There will normally be notable swelling around the back of the
heel. In other cases where the bursa lies deep under the skin in the hip or shoulder, swelling might not be visible. Movement of the ankle and foot will be stiff, especially in the mornings and after
any activity involving the elbow. All of these symptoms are experienced with septic bursitis with the addition of a high temperature of 38?C or over and feverish chills. The skin around the affected
joint will also appear to be red and will feel incredibly warm to the touch. In cases of septic bursitis it is important that you seek medical attention. With injury induced bursitis if symptoms are
still persisting after 2 weeks then report to your GP.
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
With posterior Achilles tendon bursitis, treatment is aimed at reducing the inflammation and adjusting the foot's position in the shoe to relieve pressure and motion on the back of the heel. Foam
rubber or felt heel pads can be placed in the shoe to eliminate pressure by elevating the heel. Placing protective gel padding over the painful bursa or stretching the back part of the shoe and
placing padding around the inflamed bursa may help. Sometimes a special shoe, such as a running shoe designed to stabilize the midsole heel, devices placed in the shoe (orthoses), or both can help to
control abnormal foot and heel motion contributing to the posterior heel irritation. Other shoes have padding that reduces irritation to the posterior heel and Achilles tendon.
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.