The retrocalcaneal bursa is a small space located between your Achilles tendon and the top of the heel bone (also known as the calcaneum). It is designed to reduce the friction between the tendon and the bone, created from repeated movements of your tendon as it moves over your calcaneus.
A normal bursa has a thin layer of synovial fluid within it. If the bursa is exposed to repeated compression or friction then the bursal lining becomes inflamed. This causes an increase in the amount of synovial fluid in the bursa. If this area is tender to touch and swollen on ultrasound, it is known as retrocalcaneal bursitis. Retro-calcaneal bursitis is common in runners and footballers but is also prevalent over the age of 40 in less active individuals.
Retrocalcaneal bursitis is often associated with an increased, inappropriate or unexpected mechanical stress. As previously discussed, this stress causes the bursa to come inflamed and painful.
Pain usually starts suddenly for various reasons:
after undertaking a new form of exercise such as hiking or running
increasing your training load too quickly
wearing a new pair of shoes.
Trauma is not commonly associated with the onset of retrocalcaneal bursitis, you simply notice a sudden onset of sharp/burning or sometimes achy pain just above your heel. Some people report the sensation of squeaking accompanying this pain when ascending and descending stairs.
Retro-calcaneal bursitis is common in runners who are training for a marathon or have increased their training miles too quickly. We always advise that you do not increase your mileage too quickly. Remember the 10% rule; do not increase your mileage by more than 10% in one week.
Bursitis usually responds well to conservative management. Physiotherapy treatment will depend on your individual assessment findings but may include soft tissue techniques and joint mobilisations. We may also advise you to purchase a heel raise to wear in your shoes or ‘off the shelf’ orthotics.
We are likely to also modify your training programme to ensure you do not irritate the area further. If you have poor foot posture, we may recommend you see a podiatrist for a more detailed assessment and to consider custom made orthotics.
Your physiotherapist will also prescribe an individualised exercise program which is likely to involve some strengthening exercises. We often find that stretches can actually further irritate the area.
Here are a few top tips you may like to try;
An off-the-shelf orthotic/foot support OR a heel raise in your shoe to take the pressure off and allow the inflammation in your bursa to settle.
Reduce your running and /or training load.
Wear supportive shoes – tight leather slip-on shoes or flat shoes especially those with poor support e.g. Nike Free trainers or Converse All-Stars can aggravate these conditions.
Calf strengthening exercises such as heel raises.
Topical anti-inflammatory creams or patches, however, talk to your pharmacist first as some people are allergic to these.
If conservative options have been unsuccessful there are a few other treatment modalities available to you.
If there is a clear bursitis on ultrasound and the pain is persistent then an ultrasound-guided injection may be offered. We have had good success with steroid injections for those chronic stubborn retro-calcaneal and sub-cutaneneous Achilles bursitis. This needs to be discussed thoroughly with your clinician prior to undertaking as there is a small risk of tendon rupture. This is an extremely rare side effect (1 in 10,000) but needs to be considered prior to undertaking a bursal injection.
An ultrasound-guided injection consists of a mixture of local anaesthetic and corticosteroid (a potent anti-inflammatory). It is injected under the guidance of a real time ultrasound scan to ensure we target the bursa specifically. A steroid injection can give you rapid pain relief to provide a window of opportunity to continue with your rehabilitation. Our goal is to get you back to full function as quickly and as safely as possible, whether that is simply walking to work or running a marathon.
This video should not serve as a replacement for professional health or medical advice.
Always consult a health professional before starting a new exercise or fitness programme.
Please stop and consult a physiotherapist if these exercises cause you pain.
