A bursa is a fluid-containing sac that is present at many areas of pressure on the body. Its job is to protect these areas of pressure by being a shock absorber. A bursitis is an abnormal
inflammation of the bursa sac caused by abnormal excessive pressure, stress and/ or strain over the area it is protecting. On the heel bone, there are two bursa sacs: one on the bottom and the other
on the back. Specifically on the bottom of the heel, it is known as an Inferior (bottom) Calcaneal (heel) Bursa. On the back of the heel, it is called the Retro (back) Calcaneal Bursa. When either of
these bursas become abnormally stressed, strained, or swollen, the result is bursitis of the heel. It is this bursitis that is the reason for pain in the heel upon arising (Poststatic Dyskinesia) in
the morning or after resting for a while. You can either develop these bursitises with or without the presence of heel spur (explanation to follow). As stated before, Morton?s Toe can cause this by
causing over pronation in the foot.
Inflammation of the calcaneal bursae is most commonly caused by repetitive overuse and cumulative trauma, as seen in runners wearing tight-fitting shoes. Such bursitis may also be associated with
conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies. In some cases, subtendinous calcaneal bursitis is caused by bursal impingement between the Achilles tendon and
an excessively prominent posterior superior aspect of a calcaneus that has been affected by Haglund deformity. With Haglund disease, impingement occurs during ankle 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.
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis but may be requested to
check for any underlying health conditions that may have triggered the bursitis.
Non Surgical Treatment
Many cases of retrocalcaneal bursitis can be resolved with self-care that is focused on reducing inflammation and eliminating activities or positions that aggravate the bursa. Some cases, however,
may become more serious and require more medical interventions. Rarely, surgery is needed. Following the R.I.C.E. formula, or Rest, Ice, Compression, and Elevation, is often sufficient to treat
aseptic bursitis. Rest. People with retrocalcaneal bursitis should avoid activities that irritate the bursa, such as jogging or excessive walking. Ice. Applying a cold compress to the back of the
ankle for about 20 minutes two or three times a day may help alleviate symptoms and decrease swelling. Compression. An elastic medical bandage (e.g. Ace? bandage) wrapped around the affected heel and
ankle can help control swelling. Elevating the affected heel. Sitting down with the leg elevated on a stool or lying down with the foot elevated on a pillow can help reduce blood flow to the area,
thereby reducing inflammation.
Do not run if you have pain. When you begin running again, avoid running fast uphill or downhill until the tendon is fully healed. Start exercising when caregivers say that it is OK. Slowly start
exercise such as bicycling when caregivers say it is OK. When doing exercises that put pressure on the ankles, such as running or walking, exercise on flat, even surfaces. Avoid doing these exercises
on very hard surfaces such as asphalt or concrete. Stretch before exercising. Always warm up your muscles and stretch gently before exercising. Do cool down exercises when you are finished. This will
loosen your muscles and decrease stress on your heel. Wear heel protectors. Use soft foam or felt heel pads (wedges or cups) to help decrease pressure against your heel. Ask your caregiver which heel
pads are the best for you. Wear well-fitting shoes. Buy running or exercise shoes that support and fit your feet well. Do not wear low-cut shoes. Talk to your caregiver or go to a special exercise
footwear store to get well-fitting athletic shoes. Ask your caregiver if you should wear specially-made shoe inserts called orthotics (or-THOT-iks). Orthotics can line up your feet in your shoes to
help you run, walk and exercise correctly.