A foot condition like heel bursitis (retrocalcaneal bursitis) can happen to anyone, and it often makes routine movements difficult, uncomfortable, or downright painful.
Whether you’re a professional or amateur athlete, someone who lives an active lifestyle, or you work in a job that requires a lot of standing or walking, having any type of foot injury can make normal activities problematic.
Understanding the causes, symptoms and treatment for heel bursitis can help people identify the issue early, treat the condition properly, and decrease the amount of downtime associated with pain and swelling at the back of the heel.
What is Heel Bursitis (Retrocalcaneal Bursitis)?
A bursa is a small, slippery, fluid-filled sac that acts as a cushion and a lubricant in the body. These sacs protect against excessive friction between bones, tendons, muscles, and skin. The body contains 140 bursae, two of which are located at the back of the heel.
Bursitis occurs when one of these normally thin sacs fills with even more fluid and becomes irritated or inflamed, causing pain and often noticeable swelling.
With bursitis in the heel, the retrocalcaneal bursa is located near the anklebone, between the heel bone and the Achilles tendon, which is why the condition is sometimes called retrocalcaneal bursitis.
The inflamed or damaged bursa in the heel can lead to a number of uncomfortable symptoms that lessen a person’s ability to move around without pain. For athletes, heel bursitis can seriously diminish their ability to perform certain activities.
What Causes Heel Bursitis?
Heel bursitis is a fairly common condition and can be caused by relatively normal activities that people take for granted.
The Following are Typical Causes of Heel Bursitis:
- Sudden increase in the intensity of workouts or other physical activities
- Overtraining in movements that include jumping, running, jogging, or walking long distances
- Poor warm-up and cool down techniques before and after exertion
- Incorrect footwear for a specific activity
- Poor fitting footwear
- Heel Spurs (Calcaneal Spurs) or other anatomical abnormalities in the foot
- Other underlying health conditions, such as arthritis, or infection in rarer cases
Knowing the symptoms of heel bursitis can help athletes and others take immediate action at the first sign of the condition. Early attention to the injury helps to decrease any potential downtime and speed up the recovery and healing process.
What are the Symptoms of Heel Bursitis?
While pain and discomfort in the heel may be the first thing that a person with bursitis in the heel notices, there may be other indications that a bursa in the heel has become irritated and inflamed.
The Symptoms of Heel Bursitis Often Include
- Swelling at the back of the heel may be a sign that the bursa sac is carrying excessive fluid, with the inflammation often presenting at just above the back of the heel bone
- Redness of the skin may also be visible, as if the skin at the back of the heel has been irritated
- Poor range of motion and stiffness is another indicator that the bursa is inflamed or damaged
- Skin that is warm to the touch or tender might be a symptom indicating heel bursitis. In rare instances, this may be caused by an infection and a person should seek medical attention to prevent any potential illness from spreading or becoming chronic
It’s important not to ignore the symptoms of heel bursitis. Early detection and treatment is a major key in preventing the condition from worsening.
Heel Bursitis Treatment
In diagnosing heel bursitis, physicians will need to physically examine the foot, as well as have a discussion about symptoms and recent physical activity.
They are also likely to request x-rays to get a better look at the heel bone, along with an MRI for clear images of the Achilles tendon to rule out any other possible problems.
When it comes to heel bursitis treatment, most experts will advise starting with conservative approaches before more serious procedures like surgery.
Heel Bursitis Treatment Usually Includes Some of the Following:
1. The RICE Method
The RICE Method (Rest, Ice, Compression, Elevation) is a popular first approach for many injuries and works well for treating the initial symptoms of heel bursitis.
The basics of RICE include Resting the heel injury, using Ice or a cold pack to reduce pain and swelling, wrapping the heel with a Compression bandage, and Elevating the heel above the heart on a pillow or cushion to allow fluid to drain and decrease swelling.
2. Anti-Inflammatory Pain Medications
Over-the-counter, non-steroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve) should be used as directed to reduce pain and minimize swelling while resting the foot and incorporating the RICE Method.
3. Physical Therapy and Heel Bursitis Exercises
Physical Therapy usually includes a series of heel bursitis exercises for stretching the Achilles tendon to reduce any pressure or impingement on the heel bursa. Other foot and ankle exercises can improve movement and strengthen the muscles and tendons in the surrounding area.
A physical therapist can recommend the best stretching exercises for recovery and also suggest proper footwear to avoid injury in the future.
4. Heel Wedges or Orthotics
Heel Wedges can be purchased online or in stores already sized to fit your foot that lessen heel pain and irritation. Custom Orthotics can be also be made for a more specific fit.
5. EPAT / Shockwave Therapy
Extracorporeal Pulse Activation Technology is commonly known as EPAT Therapy, and is an effective, non-invasive treatment approach to speed up the healing time for many types of injuries like heel bursitis.
EPAT involves delivering impulse pressure waves to damaged or injured soft-tissue in and around the heel, which reduces inflammation, increases blood flow, and helps form new blood vessels.
These pressure waves are sometimes called Shockwaves, or Shockwave Therapy, which is short for Extracorporeal Shock Wave Therapy.
EPAT / Shockwave therapy can be administered while a person is in the rest phase of RICE, during physical therapy, and even while a person is trying to maintain peak athletic performance.
Many college and professional sports teams use this advanced type of treatment therapy because it helps athletes heal and recover more quickly. For this reason it is quickly gaining popularity among the general public as well.
6. Corticosteroid Injections
Corticosteroid Injections, which are powerful anti-inflammatories, may be an option for some patients who need immediate relief, though cortisone injections can damage surrounding, healthy tissue. Individuals will also experience varying results in how long the anti-inflammatory properties actually last.
If heel bursitis is caused by an infection, a doctor may prescribe Antibiotics to clear up the infection while maintaining other treatment methods to speed up the recovery.
Surgery is rarely called for, but in extreme cases where pain lasts for up to a year, surgeons can remove damaged bursae in a procedure referred to as a bursectomy. However, any surgery comes with potential risks and all options should be thoroughly discussed with your doctor.
The recovery time for heel bursitis can take anywhere from a few days or weeks, to six months or a year depending on the severity and underlying conditions.
Getting a diagnosis as soon as the symptoms appear, and using the treatment methods outlined here early can reduce the severity of the symptoms and accelerate the recovery.