A Bursa is a small fluid filled sac that forms in areas of extra rubbing and friction. They are usually present with a bone deformity as the bone is pressed against other structures like a tendon or against the ground as you walk. The bursa acts as a shock absorber and is a way for your body to protect you from damage. When this bursa or sac like structure becomes swollen and inflammed it is called bursitis. The bursa may be anatomical meaning normally present, or it may be adventitious meaning, only present because of a problem. Many bursa are present and do not cause pain.
Bursitis has many causes, including autoimmune disorders, crystal deposition (gout and pseudogout), infectious diseases, traumatic events, and hemorrhagic disorders, as well as being secondary to overuse. Repetitive injury within the bursa results in local vasodilatation and increased vascular permeability, which stimulate the inflammatory cascade.
In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal bursa. Other symptoms may include redness and swelling at the back of the heel.
Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis, a fracture or tumor. A doctor also will try to determine if the Achilles tendon itself is a source of pain. To make a diagnosis, a doctor will use some or all of the diagnostic tools below Patient interview. A doctor will ask a patient about medical history, and to describe the onset of his or her symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask patients what types of shoes they wear and what they do for exercise. A patient's reported symptoms are important to diagnosis and treatment. The doctor will also ask what home treatments have helped the condition. Physical exam. A doctor will examine the patient's foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.
Non Surgical Treatment
Non-operative treatment is the standard approach to treating posterior heel pain. It is highly desirable to treat this condition non-operatively, as operative treatment is often associated with a prolonged recovery. Traditional non-operative treatment includes the following. Heel Lift or the Use of a Shoe with a Moderate Heel. Walking barefoot or in a flat-soled shoe increases the tension on the insertion of the Achilles tendon. Using a heel lift or a shoe with a moderate heel can help reduce the stress on the tendon and decrease the irritation caused by this condition.
Surgery is rarely done strictly for treatment of a bursitis. If any underlying cause is the reason, this may be addressed surgically. During surgery for other conditions, a bursa may be seen and removed surgically.
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