When talking about foot pain, most people envision plantar fasciitis or Achilles tendinitis. But there’s another culprit often lurking behind that nagging heel pain—retrocalcaneal bursitis. Though not a household term, it’s a condition that deserves attention, especially if you’re active, on your feet all day, or just happen to be one of the unlucky individuals whose anatomy predisposes them to this issue. Let’s dive into the details of what retrocalcaneal bursitis is, its symptoms, and how you can deal with it effectively.
What Is Retrocalcaneal Bursitis?
Retrocalcaneal bursitis is the inflammation of the bursa located just behind your Achilles tendon where it attaches to the heel bone. The bursa is a small, fluid-filled sac that acts as a cushion, reducing friction between the bone and the tendon. When this bursa becomes inflamed, the result is pain, swelling, and stiffness that can significantly hinder daily activities.
This condition often presents alongside Achilles tendinitis, creating a bit of a double-edged sword for the affected individual. In fact, research shows that 20-30% of individuals with Achilles issues also have retrocalcaneal bursitis. Given this close association, it’s essential to understand both conditions to manage the pain effectively.
Why Does It Happen? Common Causes and Risk Factors
Overuse and Repetitive Strain: One of the main culprits is overuse. Whether it’s from running, walking long distances, or standing for extended periods, repetitive motion can irritate the bursa. Runners, in particular, are vulnerable. A 2021 study published in the Journal of Sports Medicine found that 35% of distance runners had experienced symptoms consistent with retrocalcaneal bursitis at some point in their careers.
Biomechanical Factors: Anatomical factors, such as having a prominent heel bone (often called a Haglund’s deformity), can contribute significantly to the risk of developing retrocalcaneal bursitis. This condition leads to increased pressure on the bursa, especially when wearing tight-fitting shoes. A 2022 survey found that nearly 40% of people with retrocalcaneal bursitis had a visible bony protrusion on their heel.
Poor Footwear Choices: High heels, stiff dress shoes, or shoes with inadequate heel support are all common contributors. Dr. John Bennett, an orthopedic specialist, notes, “Many patients who come to my clinic with retrocalcaneal bursitis have a history of wearing shoes that either crowd the heel or lack proper support. It’s often a case of fashion over function.”
Age and Activity Level: The prevalence of retrocalcaneal bursitis also increases with age. As tendons and joints lose elasticity, the bursa becomes more prone to irritation. According to a 2023 review, individuals over 50 are twice as likely to develop heel-related bursitis compared to those in their 30s and 40s, particularly if they engage in repetitive activities or physical labor.
Identifying the Symptoms: What to Look Out For
The symptoms of retrocalcaneal bursitis can be subtle at first but tend to worsen over time:
- Pain at the back of the heel, especially during activities like walking or running.
- Swelling and redness in the area just above the heel bone.
- Stiffness in the Achilles tendon, which may be more noticeable in the morning or after periods of inactivity.
- Tenderness when pressing on the area around the heel.
It’s important to differentiate this pain from Achilles tendinitis, which tends to present with more diffuse pain along the tendon itself, rather than localized swelling just behind the heel.
Treatment Options: Finding Relief
1. Rest and Ice
First and foremost, giving your heel a break is crucial. Rest reduces the irritation, while applying ice packs (20 minutes, several times a day) can help minimize swelling. Unlike many other conditions, pushing through the pain of retrocalcaneal bursitis often leads to prolonged recovery times.
2. Anti-Inflammatory Medications
Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help manage inflammation and pain. However, it’s important to note that these provide symptom relief without addressing the root cause.
3. Physical Therapy
Dr. Susan Miller, a physical therapist, explains that incorporating specific stretching and strengthening exercises can make a significant difference in reducing symptoms and preventing recurrence. “We focus on exercises that gently stretch the Achilles tendon while strengthening the calf muscles to provide better support for the heel,” she says.
Here’s a sample table with exercises often recommended for retrocalcaneal bursitis:
| Exercise Name | Purpose | Frequency |
|---|---|---|
| Heel Drops | Stretch Achilles Tendon | 2 sets, 15 reps |
| Calf Raises | Strengthen Calf Muscles | 3 sets, 10 reps |
| Toe-to-Wall Stretch | Improve Flexibility | Hold 30 sec, 3x |
| Ankle Circles | Increase Range of Motion | 2 sets, 10 reps |
4. Footwear Adjustments
Switching to shoes that offer a softer, more supportive heel area can significantly alleviate pressure on the bursa. Shoe inserts, such as heel lifts, can also reduce tension on the Achilles tendon.
5. Corticosteroid Injections
For those whose symptoms do not improve with conservative measures, corticosteroid injections can offer relief by reducing inflammation. However, they come with risks, such as potential weakening of the Achilles tendon, so they should be approached cautiously and only under medical supervision.
Surgery: A Last Resort
In severe cases where all other treatments fail, surgical intervention may be necessary. The procedure typically involves removing the inflamed bursa and, if present, reshaping any bony deformity contributing to the condition. Dr. Bennett notes, “While surgery is effective, recovery can take several months, and physical therapy is usually required post-operatively to regain strength and flexibility.” The cost of such surgery in the United States typically ranges between $3,000 and $6,000, depending on the complexity and location of treatment.
Lifestyle Tips for Prevention
Avoid Overuse: Give your body adequate rest between high-impact activities like running or jumping. Consistent overuse is one of the key factors that contribute to developing retrocalcaneal bursitis.
Choose Proper Footwear: Ditch the high heels and opt for shoes with adequate heel cushioning and support. Look for brands known for comfort rather than just aesthetics.
Stay Away from Smoking and Alcohol: Both smoking and alcohol can impair circulation, slowing down the healing process and contributing to inflammation in joints and tendons. Eliminating these habits supports overall musculoskeletal health.
Strengthening and Flexibility Exercises: Incorporate exercises to maintain flexibility in the Achilles tendon and calf muscles. It’s much easier to prevent bursitis with regular stretching than to deal with the pain once it’s inflamed.
Our Editorial Advice for Living with Retrocalcaneal Bursitis
Retrocalcaneal bursitis can be a real pain—both literally and figuratively. The good news is that, with the right approach, it’s a manageable condition. Start by addressing your footwear and reducing repetitive activities that aggravate your heel. If you catch the symptoms early, conservative treatment like rest, ice, and physical therapy can be highly effective. Remember that the key to long-term relief often lies in preventive care: strengthening your calf muscles, wearing proper footwear, and avoiding habits that stress your feet unnecessarily.
And as always, don’t hesitate to seek professional medical advice if your symptoms persist or worsen. The sooner you address retrocalcaneal bursitis, the sooner you can get back on your feet—literally.
