Heel Bursitis: Symptoms, Causes, Treatment

What are the symptoms of heel bursitis?

Heel bursitis, also known as retrocalcaneal bursitis, is inflammation of the bursa located at the back of the heel where the Achilles tendon inserts into the calcaneus (heel bone). The symptoms of heel bursitis typically include:

1. Pain: Pain at the back of the heel, especially when walking, running, or standing for long periods. The pain may worsen with pressure or when wearing tight shoes.
2. Swelling: Swelling at the back of the heel where the Achilles tendon inserts. This swelling may be tender to the touch.
3. Redness: In some cases, the skin over the inflamed bursa may appear reddened or warm to the touch.
4. Stiffness: Stiffness or limited range of motion in the ankle joint, particularly when trying to flex or point the foot.
5. Difficulty with Footwear: Pain or discomfort may be exacerbated by wearing shoes that press against the back of the heel or irritate the inflamed bursa.
6. Painful Motion: Pain may increase when rising onto tiptoes or during activities that involve pushing off with the affected foot, such as running or jumping.

If you suspect heel bursitis, it’s important to consult with a healthcare provider for an accurate diagnosis and appropriate treatment.

What are the causes of heel bursitis?

Heel bursitis, or retrocalcaneal bursitis, is typically caused by repetitive stress or irritation to the bursa located between the Achilles tendon and the calcaneus (heel bone). The primary causes include:

1. Overuse or Repetitive Stress: Activities that involve repetitive movements of the ankle and heel, such as running, jumping, or activities that require frequent standing or walking on hard surfaces, can irritate the bursa over time.
2. Poor Footwear: Wearing shoes that do not fit properly or that lack proper cushioning and support can increase pressure on the back of the heel, leading to irritation of the bursa.
3. Direct Trauma: A sudden impact or blow to the back of the heel, such as from a fall or collision, can cause inflammation of the bursa.
4. Tight Achilles Tendon: Tightness or shortening of the Achilles tendon, often due to factors like calf muscle tightness or improper stretching, can increase stress on the bursa and contribute to bursitis.
5. Foot Deformities: Certain foot deformities, such as Haglund’s deformity (an enlargement of the bone at the back of the heel), can predispose individuals to developing heel bursitis.
6. Rheumatic Conditions: Inflammatory conditions like rheumatoid arthritis or gout can sometimes lead to inflammation of the bursa.
7. Infection: Although less common, bacterial infection of the bursa (septic bursitis) can also cause heel bursitis.

Understanding these causes can help in preventing or managing heel bursitis by addressing contributing factors and adopting appropriate preventive measures.

How is the diagnosis of heel bursitis made?

The diagnosis of heel bursitis, or retrocalcaneal bursitis, involves several steps to assess symptoms, physical examination findings, and sometimes imaging studies. Here’s how it is typically diagnosed:

1. Medical History: The doctor will discuss your symptoms, including the location and nature of pain, any recent activities or injuries that may have contributed to the pain, and factors that worsen or alleviate symptoms.
2. Physical Examination: The doctor will examine the affected heel, checking for tenderness, swelling, redness, and warmth around the back of the heel where the bursa is located. They may also assess range of motion in your ankle and foot.
3. Imaging Studies: X-rays may be ordered to rule out other conditions, such as fractures or bone spurs (Haglund’s deformity), which can contribute to heel pain. In some cases, ultrasound or MRI may be used to visualize the bursa and surrounding structures, helping to confirm the diagnosis and assess the extent of inflammation.
4. Diagnostic Injections: In certain cases where the diagnosis is unclear or to confirm the source of pain, a diagnostic injection of local anesthetic or corticosteroid into the bursa may be performed. Improvement in symptoms following the injection can help confirm the diagnosis of heel bursitis.
5. Differential Diagnosis: The doctor will consider other conditions that may cause similar symptoms, such as Achilles tendinitis, heel pad syndrome, or other types of bursitis.

Once diagnosed, treatment typically involves addressing the underlying causes (such as modifying activities or footwear), reducing inflammation (with rest, ice, and possibly medication), and physical therapy to improve flexibility and strength. Severe or persistent cases may require more advanced treatments, including injections or, rarely, surgery to remove the inflamed bursa.

What is the treatment for heel bursitis?

Treatment for heel bursitis, or retrocalcaneal bursitis, focuses on reducing inflammation, relieving pain, and preventing recurrence. Here are common approaches to managing heel bursitis:

1. Rest and Activity Modification: Avoid activities that exacerbate symptoms, such as running or prolonged standing. Rest allows the inflamed bursa to heal and reduces stress on the heel.
2. Ice Therapy: Applying ice packs to the affected area for 15-20 minutes several times a day helps reduce inflammation and pain. Be sure to wrap the ice pack in a cloth to protect the skin.
3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen can help reduce pain and inflammation. Always follow dosage instructions and consult with a healthcare provider, especially if you have other medical conditions.
4. Footwear Modification: Wear shoes with a cushioned heel and good arch support to reduce pressure on the heel. Avoid shoes that rub against the back of the heel.
5. Heel Pads or Orthotics: Inserting heel pads or shoe inserts (orthotics) can provide cushioning and support, reducing pressure on the inflamed bursa.
6. Stretching and Physical Therapy: Gentle stretching exercises for the calf muscles and Achilles tendon can help improve flexibility and reduce strain on the bursa. Physical therapy may be recommended to strengthen muscles and improve biomechanics.
7. Ultrasound or Laser Therapy: These modalities may help reduce inflammation and promote healing of the bursa.
8. Corticosteroid Injections: In cases where symptoms are severe or persistent, a corticosteroid injection directly into the bursa can provide significant relief by reducing inflammation. This is typically done under ultrasound guidance for accuracy.
9. Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses shock waves to stimulate healing in the affected area and may be considered for chronic cases.
10. Surgery: In rare cases where conservative treatments fail, surgical removal of the inflamed bursa (bursectomy) may be necessary to relieve symptoms.

It’s important to consult with a healthcare provider for an accurate diagnosis and personalized treatment plan tailored to your specific condition and needs. Early intervention and appropriate management can help improve symptoms and prevent recurrence of heel bursitis.