Retrocalcaneal Bursitis

INTRODUCTION:

Achilles tendon bursitis is a common foot pain in athletes, particularly runners. It can often be mistaken for Achilles tendinitis or can also occur in conjunction with Achilles tendinitis. A bursa is a small sack of fluid that goes between a tendon and a bone in the feet to help the tendon move smoothly over the bone. Retrocalcaneal bursitis is an inflammation of the bursa at the back of the heel bone (calcaneus). This causes pain with up-and-down movements of the foot. The Retrocalcaneal bursa in situated in the feet between the Achilles tendon and the calcaneus (heel bone). With repeated trauma the bursa can become inflamed.  It is possible for the athlete to have both Achilles tendinitis and Achilles tendon bursitis at the same time (Haglund’s syndrome).

CAUSES:

·          Overtraining in an athlete, such as with excessive increases in running mileage

·          Tight or poorly fitting shoes that produce excessive pressure at the posterior heel and ankle due to a restrictive heel counter

·          Haglund’s deformity, which causes impingement between the increased posterosuperior calcaneal prominence and Achilles tendon during dorsiflexion

 SYMPTOMS:

·          Pain at the back of the heels especially when running uphill or on soft surfaces.

·          Tenderness and swelling which might make it difficult to wear certain shoes on the feet.

·          When pressing fingers in both sides of the heel a spongy resistance may be felt.

DIAGNOSIS:

Patient history is paramount to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will look for tenderness and redness in the back of the heel.The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the Achilles tendon over the inflamed bursa. Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the Achilles tendon to the heel bone.Imaging studies such as x-ray and MRI are not usually necessary at first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.

TREATMENT: 

·          The initial treatment for retrocalcaneal bursitis is to avoid activities that cause pain and take non-steroidal anti-inflammatory medications (for example, ibuprofen). Your doctor may recommend icing the heel several times a day and may prescribe physical therapy to improve flexibility and strength around the ankle. Physical therapy serves two functions; it can help the bursitis improve and it can help prevent future recurrences.

·          Over-the-counter or custom heel wedges may help to decrease the stress placed on the attachment of the Achilles tendon and the associated bursa.

·          If these interventions are ineffective, then some health care providers may inject a small amount of steroids into the bursa. If the condition is associated with Achilles tendonitis, then casting the ankle to prevent motion for several weeks can be effective. Very rarely, surgery may be necessary to remove the inflamed bursa. 

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

·          Pain relief with electrotherapy

·          Reduce swelling

·          Strengthening of muscles

·          Regain full range of motion

·          Gait training

·          Advice to wear heel support

·          Prevention of recurrence

Visit Physioline for further Consultation and treatment