The most common bursa to be inflamed in the foot is the retrocalcaneal bursa (also referred to as the subtendinous calcaneal bursa). Located between the Achilles tendon and the heel bone (calcaneus), this is a “true” bursa that is present from birth. It acts as a cushion to protect the Achilles tendon from friction against the heel bone. Also commonly affected, the subcutaneous calcaneal bursa (also referred to as the Achilles bursa), located between the Achilles tendon and the skin, sits a little lower down the ankle towards the heel than the retrocalcaneal bursa. This bursa develops as you age, an “adventitious” bursa, to protect the tendon from friction at the back of the heel.
The calcaneal bursa can become inflamed in patients with heel spurs or in patients with poor-fitting shoes (eg, high heels). Inflammation can occur secondarily from Achilles tendinitis, especially in young athletes. Patients exhibit tenderness to palpation of the bursa anterior to the Achilles tendon on both the medial and lateral aspects. They have pain with movement, which is worsened with dorsiflexion.
Bursitis usually causes a dull pain, tenderness, and stiffness near the affected bursa. The bursa may swell and make the skin around it red and warm to the touch. Bursitis is most common in the shoulder camera.gif, elbow camera.gif, hip camera.gif, and knee camera.gif. Bursitis may also occur near the Achilles tendon or in the foot. Symptoms of bursitis may be like those of tendinopathy. Both occur in the tissues in and around the joints. Check with your doctor if your pain is severe, if the sore area becomes very hot or red, or if you have a fever.
During the physical examination of a patient with calcaneal bursitis, the physician should keep the following considerations in mind. Swelling and redness of the posterior heel (the pump bump) may be clearly apparent. The inflamed area, which may be slightly warm to the touch, is generally tender to palpation. Careful examination can help the clinician to distinguish whether the inflammation is posterior to the Achilles tendon (within the subcutaneous calcaneal bursa) or anterior to the tendon (within the subtendinous calcaneal bursa). Differentiating Achilles tendinitis/tendinosis from bursitis may be impossible. At times, the 2 conditions co-exist. Isolated subtendinous calcaneal bursitis is characterized by tenderness that is best isolated by palpating just anterior to the medial and lateral edges of the distal Achilles tendon. Conversely, insertional Achilles tendinitis is notable for tenderness that is located slightly more distally, where the Achilles tendon inserts on the posterior calcaneus. A patient with plantar fasciitis has tenderness along the posterior aspect of the sole, but he/she should not have tenderness with palpation of the posterior heel or ankle. A patient with a complete avulsion or rupture of the Achilles tendon demonstrates a palpable defect in the tendon, weakness in plantarflexion, and a positive Thompson test on physical examination. During the Thompson test, the examiner squeezes the calf. The test is negative if this maneuver results in passive plantarflexion of the ankle, which would indicate that the Achilles tendon is at least partially intact.
Non Surgical Treatment
Medications may be used to reduce the inflammation and pain of retrocalcaneal bursitis. Nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen and ketoprofen can be purchased without a prescription and used to treat mild to moderate pain. These drugs are often used in combination with a physical therapy program or other retrocalcaneal bursitis treatments.
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.