In the ankle, 2 bursae are found at the level of insertion of the Achilles tendon. The superficial one is located between the skin and the tendon, and the deep one is located between the calcaneus and the tendon. The latter is the one more commonly affected by bursitis.
Repetitive overuse injury of the ankle during long periods of running and or walking. Tight shoes. The heel counter of the shoe constantly rubbing against the back of the heel. Wearing shoes with a low cut heel counter. Abnormal foot mechanics (abnormal pronation). Poor flexibility. Inappropriate training.
Unlike Achilles tendinitis, which tends to manifest itself slightly higher on the lower leg, Achilles tendon bursitis usually creates pain and irritation at the back of the heel. Possible signs of bursitis of the Achilles tendon include difficulty to rise on toes. Standing on your toes or wearing high heels may increase the heel pain. Inflammation and tenderness. The skin around your heel can become swollen and warm to the touch. Redness may be visible. Pain in the heel. Pain tends to become more prominent when walking, running, or touching the inflamed area. Stiffness. The back of your ankle may feel a little stiff due to the swelling of the bursa.
After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including whether your pain is worse at specific times of the day or after specific activities. Any recent injury to the area. Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg. Your age and occupation. Your recreational activities, including sports and exercise programs. The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair.
Non Surgical Treatment
One of the most effective treatments for infracalcaneal bursitis is to temporarily avoid weight-bearing activities that put stress or strain on your heel bone. PRICE (protection, rest, hot/cold contrast compresses, compression, and elevation) is another good acute management technique for this foot problem. Changing your footwear is an effective long-term prevention and treatment tool for infracalcaneal bursitis. Footwear that possess a flat support base, a sufficiently wide toe box to accommodate natural toe splay, and a flexible sole are best for preventing and managing infracalcaneal bursitis. An integrated approach to this problem usually involves the use of padded socks that help reduce pressure, friction, and inflammation in your affected area. Natural anti-inflammatory agents can also be helpful in quelling inflammation, reducing pain, and improving treatment times for infracalcaneal bursitis. In rare cases, more aggressive treatment methods may be required, such as cortisone injections or surgery to drain the bursal sac.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.
After taking a history and performing a physical examination, your physician may order x-rays to rule out other disorders. Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain. Also, to reduce swelling, your physician may draw excess fluid from the bursa with a syringe and then tightly wrap and compress the joint with an elastic bandage. In severe, persistent cases surgery to remove the bursa may be necessary. For infectious bursitis, antibiotics will be prescribed.