Bursa is a fluid filled sac of tissue that is often found around the bony prominences over which tendons and soft tissues rub. This therefore helps the tendons to glide with least amount of friction.
Retrocalcaneal bursa is found behind the heel under the Achilles tendon. Retrotendoneal bursa is found on the back of the attachment of the tendon where the shoe rubs on the skin. This can cause
swelling, pain and difficulty in footwear. Sometimes there is a bony prominence on the heel bone that predisposes to this condition (Haglund?s deformity). Treatment of this can be modification of
footwear. However surgery is often required which involves excision of the bursa and also the bony prominence on the heel bone.
The most common cause for bursitis in the heel is overuse. If you repeatedly use your ankle, the bursa becomes irritated, causing swelling and inflammation. This is usually seen in individuals who do
too much walking or running. The risk for developing this condition worsens if you suddenly start an intensive workout routine without conditioning your body to become used to the intensity.
Where the tendon joins the calcaneal bone, friction can cause the spaces between the tendon, bone and skin to swell and inflame with bursitis. This constitutes a calcaneal bursa. Apart from swelling
over the back of the heel, you?ll feel acute tenderness and pain when you move it or even apply light pressure. Your swollen heel may look more red than the other one, and the swelling is often so
hard it can feel like bone, partly because it sometimes is, as a bony overgrowth can occur in chronic cases.
On physical examination, patients have tenderness at the site of the inflamed bursa. If the bursa is superficial, physical examination findings are significant for localized tenderness, warmth,
edema, and erythema of the skin. Reduced active range of motion with preserved passive range of motion is suggestive of bursitis, but the differential diagnosis includes tendinitis and muscle injury.
A decrease in both active and passive range of motion is more suggestive of other musculoskeletal disorders. In patients with chronic bursitis, the affected limb may show disuse atrophy and weakness.
Tendons may also be weakened and tender.
Non Surgical Treatment
Treatments should involve decreasing swelling, relieving pain and stress on the Achilles, correcting any biomechanical dysfunction (over-pronation or flat feet), treating scar tissue, and then
restoring strength and movement. If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper footwear to
prevent further irritation or damage.
People can lower the risk of bursitis by gradually strengthening and stretching the muscles around the joints and taking regular breaks from repetitive motion that might irritate bursae. Prolonged
time resting on the elbows or kneeling should be avoided, if it cannot be avoided, wearing cushioned elbow and knee pads can help protect the bursae. Comfortable, supportive, low-heeled shoes can
help prevent bursitis in the foot.