Overview
Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis.
Causes
If the posterior-superior portion of the heel has an abnormally large bony prominence protruding from it (called a Haglund's Deformity), in some instances it may rub against the Achilles Tendon. When this occurs, the bursa between the bone and the tendon will become inflamed, swollen, and painful. This condition is called Retrocalcaneal Bursitis. The presence of a Haglund's Deformity does not insure that these problems will occur. In order for these problems to occur, the heel and foot must be tilted in such a way as to actually force this bony prominence into the bursa and tendon.
Symptoms
What are the symptoms of heel bursitis? pain, swelling, tenderness, redness, and/or warmth at either the bottom of the heel or top of the heel, depending on the degree of swelling, pain may be a dull ache or substantial enough to cause limping, running, jumping, and walking activities may exacerbate pain, wearing poorly fitting, tight, or high-heeled shoes may exacerbate pain.
Diagnosis
Plain radiographs of the calcaneus may reveal a Haglund deformity (increased prominence of the posterosuperior aspect of the calcaneus). However, on weight-bearing lateral radiographs, the retrocalcaneal recess often appears normal even in patients with retrocalcaneal bursitis, limiting its usefulness in making this diagnosis.Radiographs may be used as a diagnostic measure to support a clinician?s diagnosis of retrocalcaneal bursitis. Individuals with retrocalcaneal bursitis may have an absence of the normal radiolucency (ie, blunting) that is seen in the posteroinferior corner of the Kager fat pad, known as the retrocalcaneal recess or bursal wedge. This may occur with or without an associated erosion of the calcaneus.
Non Surgical Treatment
Surgery should always be the last option. We believe that biologic treatments that preserve normal anatomy are very helpful, particularly for runner, athletes, and active professionals with buy schedules. All non-surgical approaches attempt to calm down the inflammation of the bursa and Achilles tendon. They do not address the bony bump, but they can substantially reduce and shrink the inflamed soft tissue. Some non-surgical treatments include Oral Anti-inflammatory Medications. NSAID's (non-steroidal anti-inflammatory medications) such as Motrin, Aleve, and Steroids (like prednisone) may help control the pain and stop the inflammation. Topical Anti-inflammatory Medications. NSAID's in cream or lotion form may be applied directly to the inflamed area. With these, there is no concern for stomach upset or other problems associated with oral medication. Ice. Ice can applied be applied right to the red, inflamed area and help calm it down. Try applying a podiatrist-approved ice pack to the affected area for 20 minutes of each hour. Just make sure you don't put ice directly against the skin. Exercises. Stretching exercises may relieve some of the tension in the Achilles tendon that started the problem. If you have Equinus Deformity (or a tight heel cord) this is critical to prevent it from coming back again. Heel lifts. Heel lifts placed inside the shoe can decrease the pressure on the Achilles tendon. Remember, pressure and friction cause the bump to become inflamed. Heel pads. Placing gel padding to cushion the Achilles tendon (at the back of the heel) can also help reduce irritation from shoes. Shoe modification. Wearing open-backed shoes, or shoes that have soft backs. This will also help stop the irritation. Physical therapy. Physical therapy, such as ultrasound, massage and stretching can all reduce the inflammation without surgery. Orthotic devices. Custom arch supports known as foot orthotics control abnormal motion in the foot that can allow the heel to tilt over and rub against the heel counter. Orthotics can decrease symptoms and help prevent it from happening again. Immobilization. In some cases, a walking cast boot or plaster/fiberglass cast is necessary to take pressure off the bursa and tendon, while allowing the area to calm down. ESWT. Extra-corporeal Shock Wave Therapy uses high energy sound waves to break up diseased tissue in the bursa and Achilles tendon and stimulate your own bodies healing processes to repair the diseased area. It may be done in the office or in a an outpatient surgery center. There is no incision and no stitches with ESWT. PRP. Platelet Rich Plasma (PRP) is a therapeutic injection. A small sample of blood is drawn from the patient and the healing factors found in the platelets are concentrated in a centrifuge. By injecting the concentrated solution right into the damaged Achilles tendon, a powerful healing can be stimulated. This can be done in the office. No hospital or surgery required.
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.
Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis.
Causes
If the posterior-superior portion of the heel has an abnormally large bony prominence protruding from it (called a Haglund's Deformity), in some instances it may rub against the Achilles Tendon. When this occurs, the bursa between the bone and the tendon will become inflamed, swollen, and painful. This condition is called Retrocalcaneal Bursitis. The presence of a Haglund's Deformity does not insure that these problems will occur. In order for these problems to occur, the heel and foot must be tilted in such a way as to actually force this bony prominence into the bursa and tendon.
Symptoms
What are the symptoms of heel bursitis? pain, swelling, tenderness, redness, and/or warmth at either the bottom of the heel or top of the heel, depending on the degree of swelling, pain may be a dull ache or substantial enough to cause limping, running, jumping, and walking activities may exacerbate pain, wearing poorly fitting, tight, or high-heeled shoes may exacerbate pain.
Diagnosis
Plain radiographs of the calcaneus may reveal a Haglund deformity (increased prominence of the posterosuperior aspect of the calcaneus). However, on weight-bearing lateral radiographs, the retrocalcaneal recess often appears normal even in patients with retrocalcaneal bursitis, limiting its usefulness in making this diagnosis.Radiographs may be used as a diagnostic measure to support a clinician?s diagnosis of retrocalcaneal bursitis. Individuals with retrocalcaneal bursitis may have an absence of the normal radiolucency (ie, blunting) that is seen in the posteroinferior corner of the Kager fat pad, known as the retrocalcaneal recess or bursal wedge. This may occur with or without an associated erosion of the calcaneus.
Non Surgical Treatment
Surgery should always be the last option. We believe that biologic treatments that preserve normal anatomy are very helpful, particularly for runner, athletes, and active professionals with buy schedules. All non-surgical approaches attempt to calm down the inflammation of the bursa and Achilles tendon. They do not address the bony bump, but they can substantially reduce and shrink the inflamed soft tissue. Some non-surgical treatments include Oral Anti-inflammatory Medications. NSAID's (non-steroidal anti-inflammatory medications) such as Motrin, Aleve, and Steroids (like prednisone) may help control the pain and stop the inflammation. Topical Anti-inflammatory Medications. NSAID's in cream or lotion form may be applied directly to the inflamed area. With these, there is no concern for stomach upset or other problems associated with oral medication. Ice. Ice can applied be applied right to the red, inflamed area and help calm it down. Try applying a podiatrist-approved ice pack to the affected area for 20 minutes of each hour. Just make sure you don't put ice directly against the skin. Exercises. Stretching exercises may relieve some of the tension in the Achilles tendon that started the problem. If you have Equinus Deformity (or a tight heel cord) this is critical to prevent it from coming back again. Heel lifts. Heel lifts placed inside the shoe can decrease the pressure on the Achilles tendon. Remember, pressure and friction cause the bump to become inflamed. Heel pads. Placing gel padding to cushion the Achilles tendon (at the back of the heel) can also help reduce irritation from shoes. Shoe modification. Wearing open-backed shoes, or shoes that have soft backs. This will also help stop the irritation. Physical therapy. Physical therapy, such as ultrasound, massage and stretching can all reduce the inflammation without surgery. Orthotic devices. Custom arch supports known as foot orthotics control abnormal motion in the foot that can allow the heel to tilt over and rub against the heel counter. Orthotics can decrease symptoms and help prevent it from happening again. Immobilization. In some cases, a walking cast boot or plaster/fiberglass cast is necessary to take pressure off the bursa and tendon, while allowing the area to calm down. ESWT. Extra-corporeal Shock Wave Therapy uses high energy sound waves to break up diseased tissue in the bursa and Achilles tendon and stimulate your own bodies healing processes to repair the diseased area. It may be done in the office or in a an outpatient surgery center. There is no incision and no stitches with ESWT. PRP. Platelet Rich Plasma (PRP) is a therapeutic injection. A small sample of blood is drawn from the patient and the healing factors found in the platelets are concentrated in a centrifuge. By injecting the concentrated solution right into the damaged Achilles tendon, a powerful healing can be stimulated. This can be done in the office. No hospital or surgery required.
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.