Bursitis of the heel (Insertional heel pain; Retrocalcaneal bursitis) is swelling of the fluid-filled sac (bursa) at the back of the heel bone.
Pain at the posterior heel or ankle is most typically triggered 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 exceptional to the insertion of the Achilles (calcaneal) tendon. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which lies between the Achilles tendon and the calcaneus. Posterior or superficial to the Achilles tendon is the subcutaneous calcaneal bursa, likewise called the Achilles bursa. This bursa is located between the skin and posterior element of the distal Achilles tendon. Inflammation of either or both of these bursa can cause pain at the posterior heel and ankle region.
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Causes of Retrocalcaneal Bursitis
A bursa serves as a cushion and lubricant in between tendons or muscles moving over bone. There are bursas around many big joints in the body, consisting of the ankle.
The retrocalcaneal bursa is located in the back of the ankle by the heel. It is where the large Achilles tendon links the calf muscles to the heel bone.
Repetitive or excessive use of the ankle can cause this bursa to become irritated and inflamed. It may be brought on by excessive walking, running, or jumping.
This condition is really frequently connected to Achilles tendinitis. Sometimes retrocalcaneal bursitis may be mistaken for Achilles tendinitis.
Threats for this condition consist of:
- Starting an extremely intense exercise schedule
- Unexpectedly increasing activity level without the right conditioning
Symptoms for Bursitis of the Heel
Symptoms consist of:
- Pain in the heel, particularly with walking, running, or when the area is touched
- Pain might worsen when rising on the toes (standing on tiptoes).
- Red, warm skin over the back of the heel.
Bursitis of the Heel Diagnosis
Your health care company will take a history to discover if you have symptoms of retrocalcaneal bursitis. A test will be done to find the area of the pain. The service provider will likewise look for tenderness and inflammation in the back of the heel.
The pain may be worse when your ankle is bent upward (dorsiflex). Or, the pain might be worse when you rise on your toes.
Most of the time, you will not require imaging research studies such as x-ray and MRI in the beginning. You may need these tests later if the first treatments do not cause improvement. Inflammation might reveal on a MRI.
Treatment Methods for Retrocalcaneal Bursitis
Your health care supplier may advise that you do the following:
- Avoid activities that cause pain.
- Put ice on the heel a number of times a day.
- Take nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen.
- Try using non-prescription or custom-made heel wedges in your shoe to help decrease stress on the heel.
- Attempt ultrasound treatment during physical therapy to reduce inflammation.
Have physical therapy to enhance flexibility and strength around the ankle. This can assist the bursitis enhance and prevent it from coming back.
If these treatments do not work, your supplier may inject a percentage of steroid medication into the bursa. After the injection, you should prevent overstretching the tendon because it can break open (rupture).
If the condition is linked to Achilles tendinitis, you might have to wear a cast on the ankle for numerous weeks. Really seldom, surgery might be had to get rid of the irritated bursa.
Physical Therapy for Intense Phase of Retrocalcaneal Bursitis
The patient with retrocalcaneal bursitis should be instructed to use ice to the posterior heel and ankle in the acute duration of the bursitis. Icing can be performed several times a day, for 15-20 minutes each. Some clinicians also promote using contrast baths.
Steady progressive extending of the Achilles tendon might assist eliminate impingement on the subtendinous bursa and can be performed in the following manner:
- Stand in front of a wall, with the affected foot flat on the floor. Lean forward toward the wall until a gentle extending is felt within the ipsilateral Achilles tendon.
- Maintain the stretch for 20-60 seconds and after that relax.
- Perform the stretches with the knee extended and then once again with the knee bent.
- To optimize the advantage of the stretching program, repeat the above steps for a number of stretches per set, a number of times daily. Avoid ballistic (ie, abrupt, jerking) stretches.
If it is essential for the patient to decrease his or her activity level due to retrocalcaneal bursitis, alternative methods of keeping strength and cardiovascular physical fitness must be recommended, such as swimming, water aerobics, and other water exercises.
This condition frequently improves in a number of weeks with the proper treatment.
When to Contact a Medical Professional
Call your health care supplier if you have heel pain or symptoms of retrocalcaneal bursitis that do not enhance with rest.
Bursitis of the Heel Prevention
Things you can do to prevent the issue consist of:
- Use appropriate type when exercising.
- Preserve as great flexibility and strength around the ankle to help prevent this condition.
- Stretch the Achilles tendon to help avoid injury.
- Wear shoes with enough arch support to decrease the quantity of stress on the tendon and inflammation in the bursa.