Retrocalcaneal bursitis is the inflammation of the retrocalcaneal bursa, which is located behind the heel bone, also known as the calcaneal bone (hence the name retrocalcaneal). The retrocalcaneal bursa is a thin, slippery, fluid-filled sac that serves as a both a cushion and lubricant between the heel bone and the Achilles tendon. Inflammation of the retrocalcaneal bursa usually results from irritation of the bursa. This irritation may be due to certain activities, an underlying health condition such as arthritis, or an abnormality of the foot, such the development of a boney prominence on the calcaneal bone, called a Haglund's deformity.
Occasionally the bursal sac can become inflamed and painful. Pain to the region is worse typically with initial weight bearing activity such as rising from bed in the morning. Swelling and warmth to the region are common. Clinical examination shows pain to palpation at the retrocalcaneus at a level just before the Achilles tendon. Increase pressure and friction of the Achilles tendon across the retrocalcaneal region is the cause of this bursitis. A high arch, tight Achilles tendon or bone spur appear to be some of the main causes of this problem. With a high arch the back portion of the calcaneus abnormally projects into the Achilles tendon region.
Your heel may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
Your doctor will examine you, including an evaluation of your gait, while you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.
Non Surgical Treatment
Rest and apply cold therapy or ice. Ice should not be applied directly to the skin as it may cause ice burns but wrap in a wet tea towel. Commercially available hot and cold packs are often more convenience than using ice. Taping the bursa with a donut shaped pad to take some of the pressure from footwear may help. A doctor may prescribe anti-inflammatory medication e.g. ibuprofen to reduce the pain and inflammation. Applying electrotherapy such as ultrasound may reduce inflammation and swelling. A steroid injection followed by 48 hours rest may be given for persistent cases. If the bursitis is particularly bad and does not respond to conservative treatment then surgery is also an option.
Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).
You may be able to prevent bursitis from happening or coming back. Continue your home treatment with rest, ice, pain relievers, and gentle exercises. When you are ready to try the activity that caused the pain, start slowly and do it for short periods or at a slower speed. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. Use ice afterward to prevent pain and swelling. Change the way you do activities with repeated movements that may strain your muscles or joints. For example if using a certain tool has caused bursitis, start switching hands or change the grip size of your tool. If sitting for long periods has caused bursitis, get up and walk around every hour. If a certain sport is causing bursitis, consider taking lessons to learn proper techniques. Have an expert check your equipment to make sure it's well suited to your size, strength, and ability. If certain activities at work may be causing bursitis, talk to your human resources department about other ways of doing your job, equipment changes, or other job assignments. Protect your joints from pressure. Cushion knees or elbows on hard surfaces, and wear shoes that fit you well and have good support.