Bursitis is an inflammation of a bursa. The heel has three areas that are involved in bursitis. Retrocalcaneal Bursa which is located between the Achilles tendon and heel bone. Subcutaneous calcaneal
bursa which is located between the skin and where the Achilles tendon attaches to the heel bone. Plantar-calcaneal bursitis is located between the heel bone and the plantar fascia (thick fibrous
tissue that inserts into the heel bone).
There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist and may include poor foot
biomechanics (particularly flat feet), inappropriate footwear (e.g. excessively tight fitting shoes), muscle weakness (particularly the calf, quadriceps and gluteals), muscle tightness (particularly
the calf), joint stiffness (particularly the ankle, subtalar joint or foot), bony anomalies of the heel bone, inappropriate or excessive training or activity, inadequate recovery periods from sport
or activity, inadequate warm up, inadequate rehabilitation following a previous Achilles injury, change in training conditions or surfaces, inappropriate running technique, inadequate fitness, poor
pelvic and core stability, poor proprioception or balance, being overweight.
Retrocalcaneal bursitis is very similar to Achilles bursitis as the bursae are very close in proximity and symptoms are almost identical however retrocalcaneal bursitis is a lot more common. The
symptoms of bursitis vary depending on whether the bursitis is the result of injury or an underlying health condition or from infection. From normal overuse and injury the pain is normally a constant
dull ache or burning pain at the back of the heel that is aggravated by any touch, pressure like tight shoes or movement of the joint. There will normally be notable swelling around the back of the
heel. In other cases where the bursa lies deep under the skin in the hip or shoulder, swelling might not be visible. Movement of the ankle and foot will be stiff, especially in the mornings and after
any activity involving the elbow. All of these symptoms are experienced with septic bursitis with the addition of a high temperature of 38?C or over and feverish chills. The skin around the affected
joint will also appear to be red and will feel incredibly warm to the touch. In cases of septic bursitis it is important that you seek medical attention. With injury induced bursitis if symptoms are
still persisting after 2 weeks then report to your GP.
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
Other than rest, once the diagnosis of heel bursitis (Achilles bursitis, Retrocalcaneal bursitis) has been confirmed then your treating doctor will either generally recommend one or more of the
following, Pain killers. Non steroid anti-inflammatory medication. A cortisone steroid injection. Surgery in extreme cases. Whilst the above may be beneficial for some people, others unfortunately
will not be suitable for such heel bursitis treatments. This may be for several reasons such as having already tried these medications with little to no benefit or not being able to take these type
of medications due to pre-existing medical conditions or alternatively some individuals may just prefer to avoid painful injections or strong medications and instead use a natural heel bursitis
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).