Retrocalcaneal bursitis, also sometimes called insertional heel pain or Achilles tendon bursitis, is an inflammatory condition. The body has bursae, which are fluid-filled sacs, around most major joints to act as cushions. Retrocalcaneal bursitis specifically affects the bursa located underneath the Achilles tendon, or at the back of the heel bone, which is called the calcaneus. When the bursa becomes inflamed, it causes pain and swelling around the ankle area.
Patients who suspect they may have retrocalcaneal bursitis should examine the heel area to see if it is red and feels warm and tender. They may also notice worsening pain when standing on their toes. The pain may also intensify when the patient walks, runs, or touches the area. Those who experience these symptoms should see a doctor for a professional diagnosis.
Typically, the doctor will diagnose retrocalcaneal bursitis with just a physical examination. He will examine the ankle to check for swelling, bending the ankle upwards and downwards, while asking the patient about any pain he experiences. In cases where the condition does not improve with initial treatment, the doctor may then order imaging tests, such as x-rays and magnetic resonance imaging (MRI).
Retrocalcaneal bursitis is typically an overuse condition. In other words, the patient likely acquired it by launching a new, aggressive workout routine, or otherwise suddenly increasing his activity level. Running, walking, and jumping in particular can lead to retrocalcaneal bursitis. Initial treatment requires refraining from strenuous activities, or any activity that results in pain. Complete immobilization is usually not recommended.
The doctor will advise the patient to place an icepack on the ankle area several times daily, for no longer than 10 minutes each time. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help relieve pain and reduce swelling. The patient may also use an orthotic, or shoe insert, to provide additional support to the area while walking. These orthotics are available over-the-counter, or they may be custom-made to fit the individual's feet.
Physical therapy is strongly recommended for patients with retrocalcaneal bursitis. The physical therapist can work with the patient on specific exercises designed to increase the strength and mobility of the ankle area. These exercises can not only help the bursa recover, it may also help prevent this condition from recurring. Some physical therapists may also recommend ultrasound treatment, which can help reduce inflammation. Ultrasound therapy aims high-frequency sound waves at the ankle to stimulate the tissues, increase blood flow, and possibly reduce healing time.
Patients who still suffer from retrocalcaneal bursitis despite these treatments may go back to the doctor. The doctor can inject a corticosteroid medication into the bursa to alleviate inflammation. Occasionally, the doctor may recommend placing a cast on the ankle for several weeks. Only in rare cases will surgery be required to remove the bursa altogether.