Pain at the posterior heel or posterior ankle is most commonly caused by pathology at the posterior calcaneus, the Achilles (calcaneal) tendon, or the associated bursae. The following bursae are
located just superior to the insertion of the Achilles tendon. Subtendinous calcaneal bursa. This bursa (also called the retrocalcaneal bursa), situated anterior (deep) to the Achilles tendon, is
located between the Achilles tendon and the calcaneus. Subcutaneous calcaneal bursa. Also called the Achilles bursa, it is found posterior (superficial) to the Achilles tendon, lying between the skin
and the posterior aspect of the distal Achilles tendon. Inflammation of one or both of these bursae can cause pain in the posterior heel and ankle regions.
Retrocalcaneal bursitis can be caused through injury or infection or be can be triggered by certain health conditions. If bursitis develops as a result of injury then it will normally be due to a
repetitive strenuous activity that encourages the calf muscles (the gastrocnemius and soleus muscle), which attach to the heel bone via the Achilles tendon, to tighten and shorten from overuse, for
example repetitively wearing high heels, running and even wearing tight shoes that pinch at the back of the heel. This puts more pressure over the bursa as the tendon rubs more tightly over it,
irritating it and triggering a painful inflammatory reaction (swelling). This risk of developing bursitis in this way is greater for those whose jobs or hobbies involve a lot of repetitive movements,
for example carpet fitters and gardeners who spend a lot of time kneeling and so are more at risk of bursitis in the knee. Runners have a greater likelihood of developing bursitis in the hip.
Bursitis can also be brought on by excessive pressure or direct impact trauma, such as banging your elbow or dropping on to your knees. Infection is a less common cause of bursitis and normally only
occurs in people who have a weakened immune system from other health issues. The infection can work its way to the bursa from a cut close to the bursa that has become infected, in these cases the
bursitis is termed as septic bursitis. Certain health conditions can also trigger the development of bursitis, such as rheumatoid arthritis and gout, amongst others.
Medical experts strongly recommend that you consult a doctor if you have any of the symptoms below. Disabling joint pain that prevents you from doing your daily activities. Pain that lasts for more
than two weeks. Excessive swelling, redness, bruising or a rash around the painful joint. Sharp or shooting pain, especially when you exercise or do something more strenuous. A fever. Any of the
above could be a sign of infection, a condition such as arthritis or a more serious injury such as a tendon tear that may require medical attention.
Diagnosis is first by clinical suspicion of symptoms. This can be mistaken for gout or infection especially in the big toe region. A diagnosis of bursitis is usually used in combination of the
underlying cause, for instance a bunion deformity, Haglund's deformity, or Heel Spur Syndrome. Many times the cause needs to be addressed to rid the problem of bursitis.
Non Surgical Treatment
Gradual and progressive stretching of the Achilles tendon. Exercises to strengthen and support the ankle. Rest or reduced weight bearing activities. Immobilisation in a cast for 4-6 weeks for severe
cases. Ice. Proper fitting and supportive footwear. Massage. Joint mobilisation. Anti-inflammatory medications: only if this does not have adverse results with the patient's current medication. Heel
pads and heel lifts. Footwear Advice. Strapping and padding Orthoses/innersoles. The orthotics prescribed and designed by the podiatrists at the Heel and Arch Pain Clinic (affiliated with Beyond
Podiatry) are made to align the foot in the correct posture. Surgery is indicated in severe cases when conservative treatment has not resolved the problem.
People can lower the risk of bursitis by gradually strengthening and stretching the muscles around the joints and taking regular breaks from repetitive motion that might irritate bursae. Prolonged
time resting on the elbows or kneeling should be avoided, if it cannot be avoided, wearing cushioned elbow and knee pads can help protect the bursae. Comfortable, supportive, low-heeled shoes can
help prevent bursitis in the foot.