Retrocalcaneal Bursitis

Retrocalcaneal Bursitis

Article by John Miller

Retrocalcaneal Bursitis

(Heel Bursitis)

What is Retrocalcaneal Bursitis?

Retrocalcaneal bursitis is the most common heel bursitis.

Retrocalcaneal bursitis is inflammation of the bursa (a small, cushioning sac located where tendons pass over areas of bone around the joints), which lies over your heel (calcaneum) where your Achilles tendon inserts.

What is Bursitis?

What are Retrocalcaneal Bursitis Symptoms?

You may experience one or more of the following symptoms:

  • Pain and swelling are occurring over the rear of your heel.
  • Pain when you are leaning on your heel, e.g. sitting with heels on the ground.
  • Increased pain when using your calf muscles. e.g. running, walking, calf raises

What Causes Retrocalcaneal Bursitis?

The retrocalcaneal bursa may be inflamed by your Achilles tendon rubbing over the bursa and causing friction against the heel bone. This injury can occur traumatically from a fall or a sport-related impact contusion.

It can also be a gradual onset via a repetitive trauma to the bursa from activities such as running and jumping (with inferior muscles control or technique) or excessive loading on your heel.

It is also a secondary injury associated with chronic conditions such as:

How is Retrocalcaneal Bursitis Diagnosed?

retrocalcaneal bursitis

Your physiotherapist or doctor will provide you with an assessment of your medical history and a physical examination of your heel and ankle. A hallmark sign is swelling or tenderness of your heel around the insertion of your Achilles tendon.

Medical imaging techniques that include ultrasound scan & MRI confirm your diagnosis.

What is Retrocalcaneal Bursitis Treatment?

Ice

Bursitis is an inflamed bursa. Daily application of ice packs is highly recommended to reduce your pain and swelling.

Medications

NSAIDs or anti-inflammatory drugs (i.e. ibuprofen). Use of these medications should be discussed with your doctor.

Corticosteroid Injections

Single injection of a corticosteroid with a local anaesthetic into the bursa may be required to stimulate your healing response. It is preferable to have this injection using ultrasound guidance.

Retrocalcaneal Bursitis Treatment

PHASE I – Pain Relief & Protection

Managing your pain. Pain is the main reason that you seek treatment for retrocalcaneal bursitis. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.

Managing your inflammation. Bursa inflammation is best eased via ice therapy and techniques or exercises that de-load the inflamed structures.

Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage etc.

PHASE II – Restoring Normal ROM, Strength

As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal ankle joint range of motion, muscle length and resting tension, muscle strength, endurance and proprioception.

Please ask your physio for their advice.

PHASE III – Restoring Full Function

The final stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their lower limbs that will determine what specific treatment goals you need to achieve.

Your physiotherapist will tailor your elbow rehabilitation to help you achieve your own functional goals.

PHASE IV – Preventing a Recurrence

Retrocalcaneal bursitis can return if you annoy your bursa. The main reason it is thought to recur is due to insufficient rehabilitation or not understanding your condition.

Retrocalcaneal Bursitis Surgery

Surgery is not a common path. However, in persistent cases, removal of the bursa – known as a bursectomy – can be performed.

How Can You Prevent Retrocalcaneal Bursitis?

Muscle weakness or fatigue is a potential cause of retrocalcaneal bursitis. So addressing your strength and endurance is necessary to avoid a recurrence.

What Results Can You Expect for Retrocalcaneal Bursitis?

While some people can respond quickly to physiotherapy treatment within a few weeks, more chronic cases where an Achilles tendinopathy, plantar fasciitis, heel spur or other lower limb injury co-exists, can require a few months to achieve recovery.

Retrocalcaneal bursitis is successfully managed in the vast majority over a period of approximately six weeks. It is important to not stop your rehabilitation exercises as soon as your pain abates. Hydrocortisone injections may be helpful in the short-term to reduce the inflammatory response within the bursa.

Please follow the advice of your physiotherapist or doctor.

Common Ankle Injuries

ankle pain

Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.

Ankle Tendinopathies

While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide you with a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist.

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion contr. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions that may cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information

FAQs about Retrocalcaneal Bursitis

Article by John Miller

Common Youth Leg Injuries

youth sports injuries

Why are Children's Injuries Different to Adults?

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas of the bones from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

Common Adolescent Leg Injuries

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones have a better blood supply and are more elastic in adolescents than in adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (anterior cruciate ligament) injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal injuries

Your meniscus is crescent-shaped cartilage between the thigh bone (femur) and lower leg bone (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive volume of training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. An ankle sprain usually improves in 2-6 weeks with the correct treatment. Your ankle physiotherapist should check even simple ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a piece of bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow and ankle are the most common locations for lower limb avulsion fractures in the young sportsperson.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries