In your calf at the back of the lower leg sit two major muscles (gastrocnemius and soleus), both held by the Achilles tendon (Equinus). Between the Achilles tendon and the heel bone is a bursa sac
called a retrocalcaneal bursa ('calcaneus' = 'heel bone' and 'retro' = 'behind'). During contraction of the calf muscles, the Achilles tendon rubs against the retrocalcaneal bursa, which can become
irritated as a result.
Bursitis is commonly caused by overuse and repeated movements. These can include daily activities such as using tools, gardening, cooking, cleaning, and typing at a keyboard. Long periods of pressure
on an area. For example, carpet layers, roofers, or gardeners who work on their knees all day can develop bursitis over the kneecap. Aging, which can cause the bursa to break down over time. Sudden
injury, such as a blow to the elbow. Bursitis can also be caused by other problems, such as arthritis or infection (septic bursitis).
In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to
wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the
Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal
bursa. Other symptoms may include redness and swelling at the back of the heel.
When a patient has pain in a joint, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x-rays,
although sometimes there are also calcium deposits in the joint that can be seen. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination
can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, and crystals, which could indicate gout.
In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the
Non Surgical Treatment
It is important to treat bursitis in the early stages to reduce the symptoms, minimize damage and maintain motion and strength in your foot. Resting your ankle, using proper cushioning, wearing
comfortable footwear and reducing any activities that add pressure on your bursa will help to reduce your pain and bursitis inflammation.
Bursectomy is a surgical procedure used to remove an inflamed or infected bursa, which is a fluid-filled sac that reduces friction between tissues of the body. Because retrocalcaneal bursitis can
cause chronic inflammation, pain and discomfort, bursectomy may be used as a treatment for the condition when it is persistent and cannot be relived with other treatments. During this procedure, a
surgeon makes small incisions so that a camera may be inserted into the joint. This camera is called an arthroscope. Another small incision is made so that surgical instruments can be inserted to
remove the inflamed bursa.
Contact your physician if bursitis pain is disabling (when movement of the joint is largely or entirely restricted), if the pain doesn?t subside after a week of self-care, or if the joint is red and
swollen. Also call your doctor if you develop a fever, which could signal infectious bursitis-a condition that especially can afflict the elbow. Except for the fever, symptoms resemble other forms of
bursitis, but infectious bursitis requires immediate medical attention.