Achilles tendon bursitis occurs mainly in young women but can develop in men. Walking in a way that repeatedly presses the soft tissue behind the heel against the stiff back support of a shoe can
cause or aggravate the bursitis. Shoes that taper sharply inward toward the posterior heel (such as high-heeled shoes) can cause irritating pressure that leads to the development of this bursitis.
Normally, only one bursa is in the heel, between the Achilles tendon and the heel bone (calcaneus). This bursa may become inflamed, swollen, and painful, resulting in anterior Achilles tendon
bursitis. Abnormal pressure and foot dysfunction can cause a protective bursa to form between the Achilles tendon and the skin. This bursa may also become inflamed, swollen, and painful, resulting in
posterior Achilles tendon bursitis. Any condition that puts extra strain on the Achilles tendon can cause anterior Achilles tendon bursitis. Injuries to the heel and diseases such as rheumatoid
arthritis can also cause it.
Occasionally the bursal sac can become inflamed and painful. Pain to the region is worse typically with initial weight bearing activity such as rising from bed in the morning. Swelling and warmth to
the region are common. Clinical examination shows pain to palpation at the retrocalcaneus at a level just before the Achilles tendon. Increase pressure and friction of the Achilles tendon across the
retrocalcaneal region is the cause of this bursitis. A high arch, tight Achilles tendon or bone spur appear to be some of the main causes of this problem. With a high arch the back portion of the
calcaneus abnormally projects into the Achilles tendon region.
Some of the symptoms of bursitis in the heel, or retrocalcaneal bursitis, are as described below. Severe pain in the heel area of the foot, sometimes radiating to the ankle, associated with physical
activities like walking, jogging and even on physical contact to the area. The physical signs of heel bursitis, which are noticeable in the heel area, are reddish discoloration of the skin that is
warm to touch.
Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis, a fracture or tumor. A doctor also will try to determine if the Achilles
tendon itself is a source of pain. To make a diagnosis, a doctor will use some or all of the diagnostic tools below Patient interview. A doctor will ask a patient about medical history, and to
describe the onset of his or her symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask patients what types of shoes they wear and what they do
for exercise. A patient's reported symptoms are important to diagnosis and treatment. The doctor will also ask what home treatments have helped the condition. Physical exam. A doctor will examine the
patient's foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.
Non Surgical Treatment
Many times, Achilles tendon bursitis can be treated with home care. However, if self-care remedies do not work, your doctor may need to administer additional treatments. Home care. The most important
thing you can do to help your healing is to refrain from activities that could further aggravate the bursitis. Typical home-care treatments for Achilles tendon bursitis include Anti-inflammatory
medication. Take over-the-counter pain medication, like aspirin or ibuprofen, to reduce pain and swelling. Heel wedges. An over-the-counter or custom heel wedge can be placed in your shoe to minimize
stress in the Achilles tendon. Ice. Apply ice or other cold therapy to your sore heel several times a day. Rest. Limit your activity on the injured leg, avoid putting pressure on it whenever
possible. Also, elevate your leg during non-use to help reduce the swelling. The above remedies may be used on their own or in combination with others on the list. Physician-administered treatments.
If the above self-care remedies are not effective, you should visit your doctor for additional treatment. Possible Achilles tendon bursitis treatments your doctor may administer include
immobilization. If the bursitis is combined with Achilles tendonitis, your doctor may place a temporary cast on the ankle to prevent movement and allow it to heal. Physical therapy. Exercises may be
used to improve the ankle's strength and flexibility. Steroids. Injection of steroids into the retrocalcaneal bursa (not the Achilles tendon) may be necessary. Surgery. In very rare circumstances,
surgery may be needed to remove the retrocalcaneal bursa, however, this is typically a last resort.
Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a
pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle
or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be
underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).
You can help to prevent heel pain and bursitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the
heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the
soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.