A bursa is a small sack of fluid that sits between a tendon and a bone to help the tendon move smoothly over the bone. The retrocalcaneal bursa in situated in the feet between the Achilles tendon and
the calcaneus or heel bone. With repeated trauma the bursa can become inflamed. Achilles tendon bursitis is often mistaken for achilles tendinitis. It is possible for the athlete to have both
achilles tendinitis and achilles tendon bursitis at the same time which is known as Haglund's syndrome.
Bursitis may be the result of a direct injury to the heel, such as during a car accident, sport-related accident, or fall that causes a forceful impact or abnormal twisting of the foot. It can also
occur due to repetitive use, misuse, or overuse, such as seen in athletic over-training. Excessive pressure over the subcutaneous calcaneal bursa, such from wearing shoes that are tight or fit
poorly, can also be a causative factor. Septic bursitis occurs secondary to an infection. The infection may occasionally be systemic, but is most often a localized infection from a subcutaneous heel
wound that leaks into the underlying bursa. Other risk factors include any of the following, existing Achilles tendinitis, existing Haglund's deformity, the natural degenerative processes of aging,
improper stretching prior to exercise, anatomical differences in the lower extremities that impacts gait, having deformed joints.
Symptoms of bursitis usually occur after rest and relaxation. Upon activity there is usually more intense pain in the area of the bursa. The common areas to have a bursitis in the foot are in the
bottom of the heel, behind the heel near the attachment of the Achilles Tendon as well as along the side of a bunion. A bursa may also form in multiple areas especially along the metatarsal heads, or
"ball" of your foot. You may actually feel the sac like fluid when rubbing the area of pain.
Diagnosis is first by clinical suspicion of symptoms. This can be mistaken for gout or infection especially in the big toe region. A diagnosis of bursitis is usually used in combination of the
underlying cause, for instance a bunion deformity, Haglund's deformity, or Heel Spur Syndrome. Many times the cause needs to be addressed to rid the problem of bursitis.
Non Surgical Treatment
Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. A sling can be used for a shoulder injury, a
cane is helpful for hip problems. The patient can take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofin, and naproxen. They can be obtained without a prescription and relieve the
pain and inflammation. Once the pain decreases, exercises of the affected area can begin. If the nearby muscles have become weak because of the disease or prolonged immobility, then exercises to
build strength and improve movement are best. A doctor or physical therapist can prescribe an effective regimen. If the bursitis is related to an inflammatory condition like arthritis or gout, then
management of that disease is needed to control the bursitis. When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation, like
prednisone, can bring immediate and lasting relief. A corticosteroid is a hormonal substance that is the most effective drug for reducing inflammation. The drug is mixed with a local anesthetic and
works on the joint within five minutes. Usually one injection is all that is needed.
Do not run if you have pain. When you begin running again, avoid running fast uphill or downhill until the tendon is fully healed. Start exercising when caregivers say that it is OK. Slowly start
exercise such as bicycling when caregivers say it is OK. When doing exercises that put pressure on the ankles, such as running or walking, exercise on flat, even surfaces. Avoid doing these exercises
on very hard surfaces such as asphalt or concrete. Stretch before exercising. Always warm up your muscles and stretch gently before exercising. Do cool down exercises when you are finished. This will
loosen your muscles and decrease stress on your heel. Wear heel protectors. Use soft foam or felt heel pads (wedges or cups) to help decrease pressure against your heel. Ask your caregiver which heel
pads are the best for you. Wear well-fitting shoes. Buy running or exercise shoes that support and fit your feet well. Do not wear low-cut shoes. Talk to your caregiver or go to a special exercise
footwear store to get well-fitting athletic shoes. Ask your caregiver if you should wear specially-made shoe inserts called orthotics (or-THOT-iks). Orthotics can line up your feet in your shoes to
help you run, walk and exercise correctly.