Bursitis is defined as inflammation of a bursa. Humans have approximately 160 bursae. These are saclike structures between skin and bone or between tendons, ligaments, and bone. The bursae are lined
by synovial tissue, which produces fluid that lubricates and reduces friction between these structures.
Posterior heel pain can come from one of several causes. When a physician is talking about posterior heel pain, he or she is referring to pain behind the heel, not below it. Pain underneath the heel,
on the bottom of the foot, has several causes including Tarsal Tunnel Syndrome. Plantar Fasciitis. Heel Spurs.
Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping.
Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of
the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).
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
Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. A sling can be used for a shoulder injury, a
cane is helpful for hip problems. The patient can take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofin, and naproxen. They can be obtained without a prescription and relieve the
pain and inflammation. Once the pain decreases, exercises of the affected area can begin. If the nearby muscles have become weak because of the disease or prolonged immobility, then exercises to
build strength and improve movement are best. A doctor or physical therapist can prescribe an effective regimen. If the bursitis is related to an inflammatory condition like arthritis or gout, then
management of that disease is needed to control the bursitis. When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation, like
prednisone, can bring immediate and lasting relief. A corticosteroid is a hormonal substance that is the most effective drug for reducing inflammation. The drug is mixed with a local anesthetic and
works on the joint within five minutes. Usually one injection is all that is needed.
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.