Swelling and inflammation near a joint may be a sign of bursitis, a condition that involves buildup of liquid and inflammation in a bursa sac that cushions a joint. This condition has earned some
interesting names over the years: housemaid?s knee, student?s elbow, and tailor?s bottom, to name a few. Simply put, bursitis is the inflammation of a bursa and buildup of fluid in the bursa sac. A
bursa is a thin, slippery sac found around a joint that serves to reduce friction between bone and surrounding soft tissue, such as skin, muscles, ligaments and tendons. A bursa sac is made up of a
synovial membrane, or synovium, that produces and contains synovial fluid. Excessive friction, a trauma, or other condition can irritate the synovium and cause it to become inflamed. The inflamed
synovium will thicken and produce excess synovial fluid, and can cause symptoms such as localized swelling, skin redness and warmth, tenderness and pain. Of the approximately 160 bursae in the body,
only a handful of them usually cause bursitis. These usual suspects are found in the knee, shoulder, elbow, and hip. Less frequently, bursitis may also occur in the heel, wrist, buttocks and big
Bursitis may be the result of a direct injury to the heel, such as during a car accident, sport-related accident, or fall that causes a forceful impact or abnormal twisting of the foot. It can also
occur due to repetitive use, misuse, or overuse, such as seen in athletic over-training. Excessive pressure over the subcutaneous calcaneal bursa, such from wearing shoes that are tight or fit
poorly, can also be a causative factor. Septic bursitis occurs secondary to an infection. The infection may occasionally be systemic, but is most often a localized infection from a subcutaneous heel
wound that leaks into the underlying bursa. Other risk factors include any of the following, existing Achilles tendinitis, existing Haglund's deformity, the natural degenerative processes of aging,
improper stretching prior to exercise, anatomical differences in the lower extremities that impacts gait, having deformed joints.
Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to
the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise the arm out from the side of
the body. Putting on a jacket or combing the hair becomes a troublesome activity. In acute bursitis symptoms appear suddenly, with chronic bursitis, pain, tenderness, and limited movement reappear
after exercise or strain.
Magnetic resonance imaging (MRI) may demonstrate bursal inflammation, but this modality probably does not offer much more information than that found by careful physical examination. Theoretically,
MRI could help the physician to determine whether the inflammation is within the subcutaneous bursa, the subtendinous bursa, or even within the tendon itself, however, such testing is generally not
necessary. Ultrasonography may be a potentially useful tool for diagnosing pathologies of the Achilles tendon.
Non Surgical Treatment
The patient with retrocalcaneal bursitis should be instructed to apply ice to the posterior heel and ankle in the acute period of the bursitis. Icing can be performed several times a day, for 15-20
minutes each. Some clinicians also advocate the use of contrast baths. Gradual progressive stretching of the Achilles tendon may help relieve impingement on the subtendinous bursa and can be
performed in the following manner. Stand in front of a wall, with the affected foot flat on the floor. Lean forward toward the wall until a gentle stretching is felt within the ipsilateral Achilles
tendon. Maintain the stretch for 20-60 seconds and then relax. Perform the stretches with the knee extended and then again with the knee flexed. To maximize the benefit of the stretching program,
repeat the above steps for several stretches per set, several times daily. Avoid ballistic (ie, abrupt, jerking) stretches. Other treatment options are microcurrent therapy and corticosteriod
injection into the retrocalcaneal bursa. If conservation treatment fails then surgery is indicated.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.
Prevention can be accomplished by controlling your foot structure with good supportive shoes or arch supports. Pay attention to early signs of friction like blister formation. This tells you where
the areas that are more likely to cause a bursa to form and subsequently a bursitis.