The foot only contains one naturally occurring bursal sac between the Achilles tendon and the heel bone, which protects the Achilles from the pressure against the heel bone during ambulation.
However, shoes may put pressure on this bursa. The bursa might also incur trauma from walking on hard ground. And, though they are not naturally occurring, bursa sacs can also form, and become
inflamed, in other parts of the foot, including the bottom of the heel, and the metatarsal plate, the outside of the foot below the fifth toe, and so on.
The retrocalcaneal bursa can become inflamed as the result of another condition, such as damage to the Achilles tendon, osteoarthritis, rheumatoid arthritis, gout, and pseudogout. In these instances,
the treatment for bursitis must accompany treatment for the underlying condition. Septic retrocalcaneal bursitis, which is caused by an infection, is uncommon. Infection can reach the bursa through a
cut, puncture, a blister, or even an insect bite. It is possible to have septic bursitis without an obvious opening. In these cases the superficial wound may have healed quickly, but still allowed
bacteria into the bursa.
Pain and tenderness usually develop slowly over time. Applying pressure to the back of the heel can cause pain. Wearing shoes may become uncomfortable. The back of the heel may feel achy. Pain is
exacerbated when the foot is pointed or flexed, because the swollen bursa can get squeezed. A person with retrocalcaneal bursitis may feel pain when standing on their toes. Fever or chills in
addition to other bursitis symptoms can be a sign of septic bursitis. Though uncommon, septic retrocalcaneal bursitis is a serious condition, and patients should seek medical care to ensure the
infection does not spread.
Your doctor will check for bursitis by asking questions about your past health and recent activities and by examining the area. If your symptoms are severe or get worse even after treatment, you may
need other tests. Your doctor may drain fluid from the bursa through a needle (aspiration) and test it for infection. Or you may need X-rays, an MRI, or an ultrasound.
Non Surgical Treatment
Rest and apply cold therapy or ice. Ice should not be applied directly to the skin as it may cause ice burns but wrap in a wet tea towel. Commercially available hot and cold packs are often more
convenience than using ice. Taping the bursa with a donut shaped pad to take some of the pressure from footwear may help. A doctor may prescribe anti-inflammatory medication e.g. ibuprofen to reduce
the pain and inflammation. Applying electrotherapy such as ultrasound may reduce inflammation and swelling. A steroid injection followed by 48 hours rest may be given for persistent cases. If the
bursitis is particularly bad and does not respond to conservative treatment then surgery is also an option.
Because many soft tissue conditions are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause problems. Underlying conditions such as leg
length differences, improper position or poor technique in sports or work must be corrected. Be aware of potential overuse or injury in your daily activities and change your lifestyle to prevent
problems. Otherwise, problems may persist or occur repeatedly. Following are some ways you can avoid future problems. Wear walking or jogging shoes that provide good support. High-top shoes provide
support for people with ankle problems. Wear comfortable shoes that fit properly. Wear heel cups or other shoe inserts as recommended by your doctor. Exercise on level, graded surfaces.