Retrocalcaneal-Bursitis

Retrocalcaneal refers to the back (retro-) of the heel bone (calcaneum). A bursa is a small fluid filled sack that provides cushioning in areas where tendons pass over bones. Retrocalcaneal bursitis is painful inflammation at the attachment of the Achilles tendon to the back of the heel bone.

Symptoms

Pain and swelling over the back of the heel

Redness and warmth in the area

Pain when leaning against heel

Pain is worse with initial weight bearing activity

Increased pain when using calf muscle (running, walking, stair climbing, jumping)

Pain when wearing shoes that rub against the heel

Bump on the back of heel

Causes

Increased pressure and friction of the Achilles tendon across the heel

A high arch, tight Achilles tendon

Overuse of calves, ankles and heels during excessive training or repetitive motions for prolonged periods

Trauma or injury to the heel

Poorly fitting shoes

Muscle weakness, joint stiffness and poor flexibility of the calf

Secondary injury to chronic conditions, such as Achilles tendonitis, plantar fasciitis, heel spurs, fibromyalgia, or rheumatoid arthritis, or gout.

Treatments

Treatment is aimed at pain relief and allowing area to heal. Rarely, surgery is necessary if conservative measures are ineffective.

Ice to area

Over the counter pain medication, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), as needed

Steroid injection

Well-fitting, soft-backed or open-backed shoe

Avoid high-heeled shoes

Heel pads and heel lifts

Custom orthotic

Gentle stretching of heel and calf

Exercise modifications / limitations

Night splint or cast boot for severe pain

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Retrocalcaneal bursitis and Haglund’s Deformity are painful conditions involving the back of the heel bone.

A fluid filled sack termed the retrocalcaneal bursa is sandwiched between the back of the heel bone and the Achilles tendon attachment. The bursa functions to decrease the friction from the heel bone on the Achilles tendon during walking. Tight calf muscles, prominence of the heel bone including bone spurs at the attachment of the Achilles tendon can cause inflammation and pain to this region.

The pain associated with Haglund’s Deformity also termed “pump bump” is a result of abnormal friction that occurs from the shoes heel counter against the outer portion of the heel bone. The pain from Haglund’s Deformity is usually more localized on the outside portion of the heel while the pain from retrocalcaneal bursitis usually fans out to the whole back of the heel at the attachment of the Achilles tendon.

Calf stretching, activity limitation as well as inflammatory medications and ice are standard treatment recommendations for both of these conditions. Additional treatments including night splints, cast boots and cortisone injections may be warranted based on the severity of the pain. Firm heel lifts used within an athletic shoe, heeled dress shoes or boots, clogs and most preferably heeled backless shoes are ideal aids in treatment. Heeled shoe wear decreases the mechanical load on the Achilles tendon and bursa during walking which substantially aids to recovery.

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