Retrocalcaneal Bursitis – Inflammation Behind the Heel

Retrocalcaneal Bursitis – Inflammation Behind the Heel Feel a sharp, burning pain deep behind your heel? You might have retrocalcaneal bursitis—inflammation of the fluid filled sac that cushions the area between your Achilles tendon and heel bone. This condition can make walking, running, and even wearing shoes uncomfortable. Understanding what's causing your pain is the first step toward relief. What Is Retrocalcaneal Bursitis? Retrocalcaneal bursitis is inflammation of the retrocalcaneal bursa, a small fluid filled sac positioned between the Achilles tendon and the calcaneus (heel bone). Bursae act as shock absorbers and reduce friction between moving structures. When irritated or inflamed, they fill with fluid and cause pain, swelling, and restricted movement. This condition is distinct from other heel pain conditions and requires specific treatment to resolve effectively. Causes and Contributing Factors Retrocalcaneal bursitis develops from various causes: Tight Achilles tendon : Increased tension pulls on the bursa Repetitive stress : Running, jumping, or prolonged walking Footwear : Rigid heel counters or tight shoes Haglund's deformity : Bony prominence irritating the bursa Overuse : Sudden increase in activity level Inflammatory conditions : Rheumatoid arthritis or seronegative spondyloarthropathy Age related changes : Degeneration of surrounding tissues Symptoms You Shouldn't Ignore Retrocalcaneal bursitis typically presents with: Pain deep behind the heel, worse with activity Swelling and redness above the heel Tenderness when touching the back of the heel Stiffness in the morning or after rest Pain that worsens with walking, running, or climbing stairs Difficulty with heel strike during walking Pain when pressing on the Achilles tendon insertion Symptoms often develop gradually and may worsen if left untreated. Diagnosis: Getting Clarity Your podiatrist will perform a comprehensive evaluation: Physical examination of the heel and Achilles tendon Palpation to localize the pain Assessment of Achilles tendon flexibility and tension Evaluation of your footwear and activity patterns Ultrasound imaging to visualize bursal inflammation X rays to rule out Haglund's deformity or other bone abnormalities MRI if further imaging is needed Accurate diagnosis ensures you receive appropriate treatment. Conservative Treatment Approaches Rest and Activity Modification Temporarily reduce high impact activities Avoid repetitive heel strike activities Take walking breaks to prevent overuse Switch to low impact exercise like swimming Physical Therapy Achilles tendon stretches and flexibility work Calf strengthening exercises Eccentric training for tendon rehabilitation Proprioceptive exercises for balance and stability Gradual return to activity progression Footwear and Orthotic Support Heel lifts (0.5 to 1 inch) to reduce Achilles tension Soft soled shoes with flexible heel counters Avoid rigid heel cups and tight footwear Custom orthotics to improve foot alignment Heel cups with bursal cutouts for pressure relief Anti Inflammatory Management Ice application (15 20 minutes, several times daily) Over the counter anti inflammatory medications Occasional NSAIDs for pain and inflammation Rest periods throughout the day Advanced Treatment Options When conservative measures haven't provided relief within 4 6 weeks: Corticosteroid Injections Your podiatrist may inject corticosteroids directly into the bursa to reduce inflammation. This often provides significant relief, especially when combined with physical therapy. Ultrasound Guided Therapy Advanced ultrasound technology guides treatment directly to the inflamed bursa, improving accuracy and outcomes. Platelet Rich Plasma (PRP) Some patients benefit from PRP injections that promote healing and reduce inflammation. Surgical Intervention If conservative and advanced conservative treatments fail after 3 6 months, surgery may be considered. Surgical options include: Bursal excision (removal of the inflamed bursa) Achilles tendon lengthening to reduce tension Removal of underlying bony prominences Combination procedures for optimal results Surgery is typically highly effective, with most patients experiencing significant pain relief. When to See a Podiatrist Consult a podiatrist if you experience: Persistent pain behind the heel Swelling or redness in the heel area Pain affecting your daily activities or exercise Symptoms lasting more than a few days Uncertainty about your diagnosis Dr. Robert Hoover at Central Florida Foot & Ankle Institute has extensive experience treating retrocalcaneal bursitis with both conservative and surgical approaches. Your Recovery Plan Retrocalcaneal bursitis is highly treatable. Most patients achieve excellent results through conservative management, especially when combined with physical therapy and appropriate footwear modifications. Early diagnosis and treatment prevent progression and get you back to your normal activities faster. Don't let h