Retrocalcaneal bursitis is a painful irritation of the small bursa that sits between your heel bone and the front of the Achilles tendon. It is one cause of heel pain, especially when walking uphill, wearing firm-backed shoes, or loading the calf hard during running and jumping.

This problem often overlaps with Achilles tendinopathy, and it can sometimes be confused with plantar fasciitis or a heel spur. A physiotherapist can assess whether the pain is mainly coming from the bursa, the tendon, or both, and then guide the right treatment plan.

Common Symptoms of Retrocalcaneal Bursitis

Retrocalcaneal bursitis usually causes pain deep at the back of the heel, just in front of the Achilles tendon. The area may feel swollen, irritated, or tender when the heel is squeezed from both sides. Many people also notice stiffness after rest and pain during calf raises, uphill walking, running, or jumping.

• Pain at the back of the heel near the Achilles insertion
• Tenderness when the heel is compressed from the sides
• Swelling or a feeling of fullness behind the heel bone
• Morning stiffness or pain after sitting
• Worse symptoms in firm shoes, hills, sprints, or hopping

What Causes Retrocalcaneal Bursitis?

This condition usually develops from repeated compression and friction between the Achilles tendon and the heel bone. Training spikes, hill running, sprint work, and stiff calf muscles can all increase pressure in this area. Shoes with a firm heel counter may also irritate the back of the heel and trigger symptoms.

Retrocalcaneal bursitis may occur on its own, but it often sits alongside bursitis elsewhere or with tendon problems such as Achilles tendinopathy. In some people, a prominent bony shape at the back of the heel increases local compression. Long-term inflammatory conditions such as rheumatoid arthritis can also make the area more irritable.

Why Does the Back of My Heel Hurt When Walking or Running?

When the back of your heel hurts during walking, running, hills, or calf raises, the problem is often linked to compression and load through the Achilles insertion region. Retrocalcaneal bursitis is one possible cause, although it can overlap with Achilles tendinopathy or other forms of heel pain. That is why a proper assessment matters.

How Is Retrocalcaneal Bursitis Diagnosed?

A physiotherapist usually diagnoses this problem by listening to your history, examining the heel, and testing Achilles loading. They will often check where the pain sits, whether squeezing the heel reproduces symptoms, how well your calf works, and whether ankle movement is limited.

Because this area commonly overlaps with other heel disorders, assessment also helps separate retrocalcaneal bursitis from Achilles rupture, insertional tendon pain, or other causes of posterior heel pain. If symptoms are persistent or unclear, your clinician may discuss imaging or medical review.

Do You Need a Scan for Retrocalcaneal Bursitis?

Most cases do not need a scan straight away. However, ultrasound or MRI may help if symptoms are severe, not settling, or there is concern about Achilles tendon damage, a large bony prominence, or another diagnosis. In general, scans are most useful when they are likely to change management rather than simply confirm irritation that is already clear on examination.

For a broader medical overview of inflamed bursae, Healthdirect also explains bursitis in plain language.

Retrocalcaneal Bursitis Treatment

Treatment aims to calm the irritated bursa, reduce compression at the back of the heel, and then rebuild calf and tendon capacity. A good plan usually combines activity modification, footwear changes, progressive exercise, and hands-on guidance rather than relying on rest alone.

Phase 1: Settle the Irritation

Early management focuses on reducing painful compression. That may mean avoiding hills, sprints, jumping, or firm-backed shoes for a period. Some people benefit from a temporary heel lift, gentle taping, or swapping into footwear that places less pressure on the back of the heel.

Phase 2: Restore Movement and Strength

Once pain settles, rehabilitation usually shifts towards ankle mobility, calf strength, and better lower-limb control. Your physiotherapist may guide isometric calf work first, then heavier calf strengthening as your symptoms allow. If tendon involvement is present, the loading plan needs to be progressed carefully.

Phase 3: Rebuild Load Tolerance

As strength improves, the next step is building tolerance for walking, stairs, gym training, and sport-specific loads. This may include single-leg heel raises, controlled return-to-run progressions, and gradual exposure to hills or faster work. If you need more guidance, PhysioWorks also has a page on bursitis treatment.

How Long Does Recovery Take?

Recovery time varies with severity, training demands, footwear, and whether the Achilles tendon is also irritated. Many people improve over six to twelve weeks when load is modified early and strengthening is progressed well. Persistent cases can take longer, especially when symptoms have been ignored for months or there is a clear compression issue from footwear or bone shape.

Frequently Asked Questions

Is retrocalcaneal bursitis the same as Achilles tendinopathy?

No. They affect nearby structures, but they are not the same condition. Retrocalcaneal bursitis involves the bursa between the heel bone and Achilles tendon, while Achilles tendinopathy affects the tendon itself. That said, both problems often occur together, so an accurate assessment matters because exercise choice, load progression, and shoe advice may need to be adjusted.

Can shoes make retrocalcaneal bursitis worse?

Yes. Shoes with a stiff or high heel counter can press directly on the back of the heel and increase irritation. This is a common reason symptoms flare, especially when the area is already inflamed. A temporary change to softer-backed shoes, a heel lift, or footwear advice from your physiotherapist may reduce compression while the heel settles.

Should I stop walking if I have retrocalcaneal bursitis?

Not always. Gentle walking on flat ground is often fine if pain stays mild and settles quickly afterwards. However, limping, increasing swelling, or pain that builds later in the day usually means the heel is not tolerating the current load. Hills, fast walking, and long periods on hard surfaces often need to be reduced for a short time.

Can retrocalcaneal bursitis come back?

Yes, it can flare again if the calf-Achilles-heel complex is not strong enough for the loads you place on it. Sudden training spikes, quick return to hills or sprinting, and shoe pressure are common triggers. Ongoing strength work, gradual load progressions, and sensible footwear choices all help reduce the risk of recurrence.

Will I need an injection or surgery?

Most people improve without surgery. Injections or surgical review are usually considered only when symptoms remain stubborn despite a good rehabilitation program and clear load modification. If imaging shows significant structural compression or combined tendon involvement, your doctor may discuss other options. Even then, rehabilitation still remains a key part of recovery.

When should I get retrocalcaneal bursitis checked?

You should book an assessment if heel pain lasts more than a couple of weeks, affects your walking, limits exercise, or keeps returning when you try to increase activity. Early assessment is also helpful when you are unsure whether the problem is the bursa, the Achilles tendon, or another heel condition, because treatment direction can differ.

Related Information

• Heel pain
• Achilles tendinopathy
• Plantar fasciitis
• Heel spur
• Bursitis
• Bursitis treatment

What to Do Next

If you have pain at the back of your heel near the Achilles insertion, early treatment usually gives the best chance of settling symptoms before they become stubborn. A physiotherapist can assess your heel, calf strength, footwear, and training load, then guide a staged plan back to walking, running, gym work, or sport.

The goal is not just to reduce pain. It is to improve how much load your heel can handle without flaring. That often means finding the right balance between protection, exercise, and return-to-activity progressions.

References

1. Pękala PA, Henry BM, Hsieh WC, et al. The Achilles tendon and the retrocalcaneal bursa: an anatomical and radiological study. Foot Ankle Surg. 2017;23(4):287-292.
2. Choo YJ, Park YU. Rearfoot disorders and conservative treatment: a narrative review. Ann Palliat Med. 2020;9(5):3812-3821.
3. Silbernagel KG, Hanlon S, Sprague A. Current clinical concepts: conservative management of Achilles tendinopathy. J Athl Train. 2020;55(5):438-447.
4. Pabón MAM, Aiyer A, Deyer TW. Achilles Tendinopathy. StatPearls Publishing; 2023.