Achilles tendon bursitis, or retrocalcaneal bursitis, can affect anyone, but is typically a foot condition in athletes, especially runners. Because of similar symptoms, this condition is often
confused with Achilles tendinitis. At times, bursitis of the Achilles tendon can occur in conjunction with Achilles tendinitis. When both conditions are present, it is referred to as Haglund's
syndrome. If you are a runner and are experiencing pain in your lower leg and heel area, you may be suffering from Achilles tendon bursitis. Proper treatment of the condition can help relieve the
pain and allow your leg to heal.
Pain at the posterior heel or ankle is most commonly caused by pathology at either the posterior calcaneus (at the calcaneal insertion site of the Achilles tendon) or at its associated bursae. Two
bursae are located just superior to the insertion of the Achilles (calcaneal) tendon. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the Achilles
tendon and the calcaneus. Posterior or superficial to the Achilles tendon is the subcutaneous calcaneal bursa, also called the Achilles bursa. This bursa is located between the skin and posterior
aspect of the distal Achilles tendon. Inflammation of either or both of these bursa can cause pain at the posterior heel and ankle region.
Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to
the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise the arm out from the side of
the body. Putting on a jacket or combing the hair becomes a troublesome activity. In acute bursitis symptoms appear suddenly, with chronic bursitis, pain, tenderness, and limited movement reappear
after exercise or strain.
Like all other forms of bursitis, initially the physician will take down the history of symptoms experienced by the patient, this will be followed by a detailed physical examination which involves
checking for inflammation signs like pain, redness, and warmth of the heel area. The physician might examine further by moving the ankle a little to determine the exact location of pain. Further
diagnostic tests including x-ray, bone scans, and MRI scan might be suggested if required.
Non Surgical Treatment
Most bursitis cases can be treated by the patient without having to see a doctor. A trip to a pharmacy, a conversation with the pharmacist, and some self-care techniques are usually enough. The NHS
(National Health Service, UK) recommends PRICEM, a self-care management approach. PRICEM stands for Protection. Rest. Ice. Compression. Elevation. Medication. Protect the affected area, Some people
place padding to protect the affected bursae from any blow. Rest. Do not exercise or use the joints in the affected area unless you really have to. Let it rest. Bursitis is a condition that responds
well to rest. Ice packs. Ice packs can help reduce pain and inflammation. Make sure you do not place the ice directly on the skin, use a pack or towel. A small pack of frozen vegetables are ideal.
Raise the affected area. If you can, lift the affected area, raise it, less blood will gather there. This may help reduce the inflammation. Painkillers. Ibuprofen is an effective painkiller for
treating pain, it also reduces inflammation. Steroids. For more severe symptoms the doctor may inject steroids into the affected area. Steroids block a body chemical called prostaglandin.
Prostaglandin causes inflammation. Steroids may raise the patient's blood pressure if used for too long, as well as increasing his/her risk of getting an infection. UK doctors are advised not to give
more than three steroid injections in one year. Antibiotics. If the fluid test confirms that there is a bacterial infection, the doctor will probably prescribe antibiotics. These will be administered
orally (via mouth).
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.