There is a thick walled fluid filled bursa between the Achilles tendon and the calcaneal bone. The color Doppler images show hypervascularity of the bursal wall. A minimal amount of fluid in the retrocalcaneal bursa can often be found. A retrocalcaneal bursitis is caused by friction of the Achilles tendon over the upper part of the calcaneal bone. It is often an overuse injury found in athletes.
Age. Bursitis is more common during middle age due to repetitive activities that put wear and tear on the body over time. Certain activities or occupations. If your job or hobby involves repetitive motion or puts pressure on bursae, you have a higher likelihood of developing bursitis. Reaching overhead, leaning elbows on arm rests, crossing your legs, laying carpet, setting tile, gardening, biking, playing baseball and ice skating are some activities that, when repeated very often, can put you at increased risk of developing bursitis. Sports in which you may get hit in the knee or fall to the knees, such as football, can also increase the risk. Some medical or health conditions. Rheumatoid arthritis, osteoarthritis, gout, thyroid disease, diabetes, alcoholism and some immunosuppressive disorders can increase the risk of bursitis. The reasons can vary, from cartilage breakdown around joints (arthritis) to crystals in the bursa that cause inflammation (gout). Wearing high heels. Posterior Achilles tendon bursitis occurs when the bursa located between the skin and the Achilles tendon (the band of tissue that attaches the calf muscle to the heel bone) becomes inflamed. High heels are often to blame for this, the stiff heel can put direct pressure on the bursa between the skin and the Achilles tendon.
Common signs and symptoms associated with infracalcaneal bursitis include redness under the heel. Pain and swelling under the heel. Pain or ache in the middle part of the underside of the heel. Heel pain or discomfort that increases with prolonged weight-bearing activities.
Carrying out a diagnosis for bursitis is fairly straightforward. The doctor will examine the affected area and ask the patient some questions about his/her recent activities. If the patient has a high temperature the physician may take a small sample of fluid from a bursa near the affected body part. The sample will be tested for bacteria, and perhaps also crystals. If the patient does not get better after treatment the doctor may carry out further tests so that he/she can eliminate the possibility that the symptoms might not be due to something else. These may include an x-ray, to make sure no bones are broken or fractured. Blood tests, to check for rheumatoid arthritis. A CT scan or MRI scan to see if there is a torn tendon.
Non Surgical Treatment
There are a variety of treatments for bursitis of the heel. Bursitis on the bottom of your heel (which is called infracalcaneal bursitis) is common in heels with thinning fat pads. Gel heel cushions or custom made orthotics (that have a horse-shoe cut and extra foam in the heel) can be lifesavers in reducing the pain. For bursitis of the posterior heel (retrocalcaneal bursitis), try to avoid going barefoot and to reduce the stress on the Achilles tendon by not over flexing your heel, the tighter your Achilles becomes, the more you compress the bursa sacs of the posterior heel. Heel lifts can help this, or wearing shoes with elevated heels (note that this method is not sanctioning high heels, as high heels can provide little comfort or support and usually are tight in the areas where your bursitis is most inflamed). Products such as AirHeel made by Aircast can help massage the bottom and back of the heel, helping to decrease pain.
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.