Infracalcaneal bursitis can significantly affect your quality of life and your ability to perform your activities of daily living, due to pain and impaired gait. Inflammation of the bursal sac under
your heel bone occurs because the bursa is abnormally stressed or strained in some way or bears excessive pressure for prolonged periods. Constant pressure and friction from footwear is a common
cause of this health problem, and any treatment plan addressing infracalcaneal bursitis should include recommendations for footwear to avoid or use. Infracalcaneal bursitis may be diagnosed in
several ways, including palpation, or light pressure applied to your affected area. If your heel pain has existed for an extended period, X-ray imaging studies may reveal localized calcification in
your infracalcaneal bursa, though this is not always the case. MRI images are sometimes used as a diagnostic tool for this health problem, though MRI studies are considered unnecessary for diagnosis
in many cases.
High impact activity, such as running. Trauma to the heel such as jumping from a height. Increase in training levels. Lack of shock absorbency in the trainers worn. Worn running shoes. Poor
biomechanics. Loss of the fat pad under the heel. Increase in weight.
Achiness or stiffness in the affected joint. Worse pain when you press on or move the joint. A joint that looks red and swollen (especially when the bursae in the knee or elbow are affected). A joint
that feels warm to the touch, compared to the unaffected joint, which could be a sign that you have an infection in the bursa. A ?squishy? feeling when you touch the affected part. Symptoms that
rapidly reappear after an injury or sharp blow to the affected area.
When you suspect you have retrocalcaneal bursitis, your foot doctor will begin by taking a complete history of the condition. A physical exam will also be performed. X-rays are usually taken on the
first visit as well to determine the shape of the heel bone, joint alignment in the rearfoot, and to look for calcium deposits in the Achilles tendon. The history, exam and x-rays may sufficient for
your foot surgeon to get an idea of the treatment that will be required. In some cases, it may be necessary to get an ultrasound or MRI to further evaluate the Achilles tendon or its associated
bursa. While calcium deposits can show up on xray, the inflammation in the tendon and bursa will show up much better on ultrasound and MRI. The results of these tests can usually be explained on the
first visit. You can then have a full understanding of how the problem started, what you can do to treat prevent it from getting worse/ You will also know which treatment will be most helpful in
making your heel pain go away.
Non Surgical Treatment
Many cases of retrocalcaneal and retroachilles bursitis can be treated effectively at home. One of the most important factors is eliminating shoe gear that presses against the back of the heel.
Comfortable, supportive footwear and frequently resting the foot will minimize friction at the heel and give the inflammation a chance to subside. These steps, along with other methods to alleviate
swelling, such as non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen), icing the heel, and elevating the foot, are usually successful in treating retrocalcaneal bursitis.
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.
People can lower the risk of bursitis by gradually strengthening and stretching the muscles around the joints and taking regular breaks from repetitive motion that might irritate bursae. Prolonged
time resting on the elbows or kneeling should be avoided, if it cannot be avoided, wearing cushioned elbow and knee pads can help protect the bursae. Comfortable, supportive, low-heeled shoes can
help prevent bursitis in the foot.