Retrocalcaneal Bursitis. This bursa is located at the back of the heel. Bursitis in this area is often associated with conditions such as ankylosing spondylitis or rheumatoid arthritis. It can occur in healthy individuals who wear improperly fitted shoes. Symptoms include painful swelling that develops at the back of the heel. Calcaneal Bursitis. This bursa is located at the sole or bottom of the heel. Inflammation usually produces pain in the heel when standing. Causes include heel spurs, excess weight, injury, and wearing improperly fitted shoes.
Certain medical conditions and medications suppress people’s immune systems and make them more susceptible to septic bursitis. For example, people with cancer, HIV/AIDS, lupus, alcoholism, chronic obstructive pulmonary disease (COPD), and diabetes may be more likely to get septic bursitis. History of inflammation of the bursa. Patients who have had bursitis in the past have an increased chance of getting it again. There may be more than one reason why the retrocalcaneal bursa is inflamed. In these cases, treatment should address all of the causes.
Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa. Direct pressure on the bursa will exacerbate the pain and should be avoided if possible. Tenderness and swelling which might make it difficult to wear certain shoes on the feet. As the bursa becomes more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a “pump bump”, and is usually red, and extremely tender. Swelling can cause difficulties moving as the range of motion in the ankle can be affected. Limping due to the pain may occur. If you press on both sides of the inflamed heel, there may be a firm spongy feeling. Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads. Possibly a fever if you are suffering from septic bursitis (You will need to see a doctor for medication to get rid of the infection). Pain at the back of the heel makes it difficult to continue wearing shoes, especially high heels with straps or shoes that don’t fit properly.
Plain radiographs of the calcaneus may reveal a Haglund deformity (increased prominence of the posterosuperior aspect of the calcaneus). However, on weight-bearing lateral radiographs, the retrocalcaneal recess often appears normal even in patients with retrocalcaneal bursitis, limiting its usefulness in making this diagnosis.Radiographs may be used as a diagnostic measure to support a clinician?s diagnosis of retrocalcaneal bursitis. Individuals with retrocalcaneal bursitis may have an absence of the normal radiolucency (ie, blunting) that is seen in the posteroinferior corner of the Kager fat pad, known as the retrocalcaneal recess or bursal wedge. This may occur with or without an associated erosion of the calcaneus.
Non Surgical Treatment
So what can you do to alleviate this type of pain in the foot? If the bursitis pain is occurring on the toes, bunion or back of the heel area the smart money would be on eliminating the shoes that seem to aggravate the condition. Eliminating these shoes may not in itself clear up the problem but you can be sure that if you continue to wear the offending shoes nothing you or your doctor do will permanently ?fix? the problem. A recurring theme that I use throughout this site that if you put an abnormally shaped foot in a dressy shoe it is literally the same as trying to put a square peg in a round hole, it will not fit. OK, so you threw away those dressy shoes and the foot still hurts, now what? Depending on the severity of the pain, over the counter anti-inflammatory medication may do the trick. The key here is to take the medication on an ongoing basis, according to the directions on the package to build up therapeutic blood levels. Assuming you can tolerate this type of medication, along with alternative treatments you can try). take the medication for 10-14 days. Stop if the symptoms have not dramatically improved. Icing the area during this period may also help reduce the symptoms.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.