Heel pain: Retrocalcaneal Bursitis

The deep retrocalcaneal bursa (DRB) is a true anatomical bursa, unlike a superficial calcaneal bursa, which is an adventitious bursa that forms as a result of excessive forces (stress) acting upon the Achilles tendon and its insertion onto the calcaneus. Pathological changes can occur in the DRB in response to mechanical irritation, usually rubbing of the heel against footwear, leading to inflammation, swelling and pain. This rubbing can be due to poor fitting shoes or issues with how the foot moves and how the person walks (foot, ankle and lower limb biomechanics). When the DRB becomes inflamed, we call this condition, “Retrocalcaneal Bursitis”.

Patients with Retrocalcaneal Bursitis present with diffuse pain at the posterior (back end) of the calcaneus (heel bone) that often leads to a reduction in normal activities, such as walking and other forms of exercise. Diagnosis is usually made by taking a history of the condition and symptoms, and by palpation of the DRB.

Differential diagnoses are: Superficial Calcaneal Bursitis, Insertional Achille’s Tendinopathy, and Sever’s Disease. Retrocalcaneal Bursitis can also occur in certain conditions, such as Rheumatoid Disease (“Rheumatoid Arthritis”) and seronegative spondyloarthropathies, such as Reiters’ Syndrome and Ankylosing Spondylitis.

Conservative (non-surgical) podiatry treatment usually involves changes in footwear or modifying shoes with padding, functional foot orthoses to control biomechanical abnormalities in the foot, particularly those that lead to excessive frontal plane movement of the rearfoot (inversion and eversion), topical or oral analgesics (pain relief medication), typically NSAIDs, acupuncture to reduce pain and inflammation, and rest, ice, compression and elevation (RICE) in the early (acute) stages or during acute flare ups. In cases of autoimmune disease, the patient will be referred to their rheumatologist.

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