Overview
This is a very common condition that leads to foot pain . Once you understand what it actually is you will wonder why it does not occur more often, particularly in the foot. It is an inflamed bursal sac. A bursal sac is a sac filled with fluid that acts to lubricate and reduce the friction between two surfaces in the body, usually muscles and tendons as they glide over bony prominences, however their purpose in not limited to just muscles and tendons. The body contains literally hundreds of bursal sacs but in the foot there is just one naturally occurring (adventitious) bursal sac. It is located between the Achilles tendon and the heel bone (calcaneaus), otherwise known as an achilles tendon bursal sac.In this instance the Achilles tendon is protected from the pressure of the heel bone pressing against it when we walk.
Causes
A rapid increase in physical activity levels or thinning of the heel?s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible causes of infracalcaneal bursitis include blunt force trauma, acute or chronic infection, and arthritic conditions. The following factors may increase your risk of experiencing bursitis, including infracalcaneal bursitis. Participating in contact sports. Having a previous history of bursitis in any joint. Poor conditioning. Exposure to cold weather. Heel striking when running, especially in conventional running shoes with heel elevation.
Symptoms
Some of the symptoms of bursitis in the heel, or retrocalcaneal bursitis, are as described below. Severe pain in the heel area of the foot, sometimes radiating to the ankle, associated with physical activities like walking, jogging and even on physical contact to the area. The physical signs of heel bursitis, which are noticeable in the heel area, are reddish discoloration of the skin that is warm to touch.
Diagnosis
A good clinical practise includes evaluation of the tendon, bursa and calcaneum by, careful history, inspection of the region for bony prominence and local swelling as well as palpation of the area of maximal tenderness. Biomechanical abnormalities, joint stiffness and proximal soft tissue tightening can exacerbate an anatomical predisposition to retrocalcaneal bursitis, they warrant correction when present.
Non Surgical Treatment
Caregivers may give you special shoe inserts with a cutout around the tender area. You may also be told to wear shoes with a reinforced heel counter. This will give better heel control. You may need other shoe inserts (wedges) to raise your heel so it does not press against the back of the shoe. You may also wear shoes that are open in the back, such as sandals that have no strap across the heel. You may use ibuprofen (eye-bu-PROH-fen) and acetaminophen (a-seet-a-MIN-oh-fen) medicine for your pain. These may be bought over-the-counter at drug or grocery stores. Do not take ibuprofen if you are allergic to aspirin. You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your ankle is healed and that you can return to heavy exercise. It is important to not exercise until your caregiver says it is OK. You could make the bursitis worse if you exercise too soon. You may need surgery to remove the bursa or part of your ankle bone. Surgery is usually not necessary unless the bursitis is very bad and does not heal with other treatments. Your caregiver may want you to go to physical (FIZ-i-kal) therapy (THER-ah-pee). Physical therapists may use ultrasound to increase blood flow to the injured area. Caregivers may use massage to stretch the tissue and bring heat to the injury to increase blood flow. These and other treatments may help the bursitis heal faster. Exercises to stretch your Achilles tendon and make it stronger will be started after the bursitis has healed. You may gradually increase the amount of weight you put on your foot when caregivers say it is OK. You may be told to stop exercising if you feel any pain.
Surgical Treatment
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.
Prevention
Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition. Proper stretching of the Achilles tendon helps prevent injury.
This is a very common condition that leads to foot pain . Once you understand what it actually is you will wonder why it does not occur more often, particularly in the foot. It is an inflamed bursal sac. A bursal sac is a sac filled with fluid that acts to lubricate and reduce the friction between two surfaces in the body, usually muscles and tendons as they glide over bony prominences, however their purpose in not limited to just muscles and tendons. The body contains literally hundreds of bursal sacs but in the foot there is just one naturally occurring (adventitious) bursal sac. It is located between the Achilles tendon and the heel bone (calcaneaus), otherwise known as an achilles tendon bursal sac.In this instance the Achilles tendon is protected from the pressure of the heel bone pressing against it when we walk.
Causes
A rapid increase in physical activity levels or thinning of the heel?s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible causes of infracalcaneal bursitis include blunt force trauma, acute or chronic infection, and arthritic conditions. The following factors may increase your risk of experiencing bursitis, including infracalcaneal bursitis. Participating in contact sports. Having a previous history of bursitis in any joint. Poor conditioning. Exposure to cold weather. Heel striking when running, especially in conventional running shoes with heel elevation.
Symptoms
Some of the symptoms of bursitis in the heel, or retrocalcaneal bursitis, are as described below. Severe pain in the heel area of the foot, sometimes radiating to the ankle, associated with physical activities like walking, jogging and even on physical contact to the area. The physical signs of heel bursitis, which are noticeable in the heel area, are reddish discoloration of the skin that is warm to touch.
Diagnosis
A good clinical practise includes evaluation of the tendon, bursa and calcaneum by, careful history, inspection of the region for bony prominence and local swelling as well as palpation of the area of maximal tenderness. Biomechanical abnormalities, joint stiffness and proximal soft tissue tightening can exacerbate an anatomical predisposition to retrocalcaneal bursitis, they warrant correction when present.
Non Surgical Treatment
Caregivers may give you special shoe inserts with a cutout around the tender area. You may also be told to wear shoes with a reinforced heel counter. This will give better heel control. You may need other shoe inserts (wedges) to raise your heel so it does not press against the back of the shoe. You may also wear shoes that are open in the back, such as sandals that have no strap across the heel. You may use ibuprofen (eye-bu-PROH-fen) and acetaminophen (a-seet-a-MIN-oh-fen) medicine for your pain. These may be bought over-the-counter at drug or grocery stores. Do not take ibuprofen if you are allergic to aspirin. You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your ankle is healed and that you can return to heavy exercise. It is important to not exercise until your caregiver says it is OK. You could make the bursitis worse if you exercise too soon. You may need surgery to remove the bursa or part of your ankle bone. Surgery is usually not necessary unless the bursitis is very bad and does not heal with other treatments. Your caregiver may want you to go to physical (FIZ-i-kal) therapy (THER-ah-pee). Physical therapists may use ultrasound to increase blood flow to the injured area. Caregivers may use massage to stretch the tissue and bring heat to the injury to increase blood flow. These and other treatments may help the bursitis heal faster. Exercises to stretch your Achilles tendon and make it stronger will be started after the bursitis has healed. You may gradually increase the amount of weight you put on your foot when caregivers say it is OK. You may be told to stop exercising if you feel any pain.
Surgical Treatment
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.
Prevention
Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition. Proper stretching of the Achilles tendon helps prevent injury.
