What Causes Retrocalcaneal Bursitis?

The bursa usually becomes irritated when its recent load exceeds its current tolerance. Contributing factors may include:

• a rapid increase in walking, running, hills, stairs or jumping;

• repeated deep ankle dorsiflexion that compresses the tissues at the back of the heel;

• firm or poorly fitting shoe counters;

• reduced calf strength or a sudden return to sport;

• an associated Haglund prominence or insertional Achilles tendon change; and

• less commonly, an inflammatory condition such as rheumatoid arthritis, gout or a spondyloarthritis.

The presence of one factor does not prove the cause. Assessment should consider your symptoms, recent activity changes, footwear, medical history and the capacity of the whole lower limb.

How Is Retrocalcaneal Bursitis Diagnosed?

Diagnosis usually starts with a clinical assessment. Your physiotherapist may review pain location, swelling, walking pattern, ankle movement, calf strength, footwear and recent changes in activity. The assessment also checks the Achilles tendon and screens for other causes of heel pain.

A scan is not always required at the first appointment. Ultrasound can show the bursa and Achilles tendon, while an X-ray may help identify a bony prominence or another bone-related concern. MRI may be considered when symptoms remain unclear, a more serious condition is suspected or treatment is not progressing as expected.

Scan findings need clinical context. A prominent heel bone, bursal fluid or tendon change may be present without being the main source of pain.

Retrocalcaneal Bursitis Treatment

Treatment should match the structures involved, symptom severity and your goals. Most people start with non-surgical care. Complete rest is rarely the long-term answer, but temporarily reducing the most aggravating load can help settle a sensitive heel.

Phase 1: Settle Irritation and Reduce Compression

Early management may include reducing hills, running, jumping or repeated deep ankle bending. Softer-backed footwear, loosening the shoe counter or a short-term heel lift may reduce local pressure for some people. A clinician should check that any insert suits both sides and does not create another problem.

Ice may provide short-term comfort when the area feels hot or sore. If you are considering anti-inflammatory medicine, ask your GP or pharmacist whether it is appropriate for your health and current medicines.

Phase 2: Restore Movement and Calf Capacity

Rehabilitation may begin with comfortable ankle movement and calf exercises performed within a tolerable range. The program can then progress from supported calf raises to heavier or single-leg work as symptoms allow. Foot, knee and hip strength may also matter for walking, running and sport.

Avoid forcing deep calf stretches or dropping the heel below a step when these movements increase pain at the Achilles insertion. Evidence for reduced-compression rehabilitation applies to insertional Achilles tendinopathy, not isolated bursitis, but it is relevant when the tendon and bursa are both involved.

Phase 3: Rebuild Walking, Running and Sport Tolerance

The next step is to increase walking distance, hills, speed and impact gradually. Runners may progress from flat walking to walk-jog intervals before adding sustained running, hills or faster work. Jumping athletes need a staged return to hopping, landing and sport-specific drills.

Your response later that day and the next morning helps guide progression. A small, short-lived symptom increase may be acceptable, but a clear rise that does not settle suggests the last increase was too large.

How Long Does Retrocalcaneal Bursitis Take to Improve?

There is no reliable fixed recovery time. Recent, mild irritation may begin to improve within several weeks. Longstanding symptoms, insertional Achilles involvement, inflammatory disease or persistent bony compression can take several months.

Progress is usually judged by better walking tolerance, less next-morning pain, improving calf strength and a gradual return to normal activity. Review is sensible when symptoms are worsening, repeatedly returning or not changing despite an appropriate plan.

Do Injections or Surgery Help?

An injection is not usually the first step. Image-guided corticosteroid injection may reduce pain in some people over the short term. In a 2021 cohort of 218 image-guided retrocalcaneal bursa injections, 63% recorded a good or excellent short-term pain response. Achilles rupture was reported after 1.8% of injections, with each rupture preceded by a later acute injury. The study does not prove that the injection caused those ruptures, but it supports careful medical selection, image guidance and post-injection load advice.

Surgery is uncommon for isolated bursitis. A foot and ankle surgeon may consider it when substantial symptoms persist despite an adequate course of non-surgical care, particularly when a Haglund prominence or significant Achilles tendon disease is also present. Options and recovery depend on which structures require treatment.

Retrocalcaneal Bursitis FAQs

What to Do Next

1. Reduce the main irritant

   Temporarily adjust the activity, footwear or ankle position that clearly increases symptoms.

2. Clarify the painful structure

   Arrange an assessment if pain is limiting, recurrent or unclear so the bursa, Achilles tendon and heel bone can be considered together.

3. Rebuild capacity progressively

   Use a staged calf, walking and sport program rather than repeatedly testing the heel with sudden load increases.

References

1. Healthdirect Australia. Bursitis. Healthdirect Australia. Reviewed July 2025.
2. Choo YJ. Rearfoot disorders and conservative treatment: a narrative review. Annals of Palliative Medicine. 2020;9(5):3546–3557. doi:10.21037/apm-20-446.
3. Boone SL, et al. Safety and efficacy of image-guided retrocalcaneal bursa corticosteroid injection for the treatment of retrocalcaneal bursitis. Skeletal Radiology. 2021;50(12):2471–2482.
4. Pringels L, Capelleman R, Van den Abeele A, et al. Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial. British Journal of Sports Medicine. 2025;59(9):640–650. doi:10.1136/bjsports-2024-109138.
5. Medina Pabón MA, Bergman R, Naqvi U. Achilles Tendinopathy. StatPearls. Updated 8 June 2026.
6. Yuen WLP, Tan PT, Kon KKC. Surgical Treatment of Haglund’s Deformity: A Systematic Review and Meta-Analysis. Cureus. 2022;14(7):e27500. doi:10.7759/cureus.27500.