Calcaneal bursitis is seen somewhat frequently, particularly if the clinician has a predominantly musculoskeletal practice. No mortality is associated with calcaneal bursitis. Morbidity is associated with progressive pain and limping (antalgic gait) in patients who have not received adequate treatment. If chronic inflammation also affects the distal Achilles tendon, rupture of the tendon may occur. No race predilection has been documented. Calcaneal bursitis is observed in men and women. However, some increased risk may be incurred by women who wear high-heeled shoes. Calcaneal bursitis is commonly observed in middle-aged and elderly persons, the condition is also seen in athletes of all ages.Bursitis is a painful swelling of a small sac of fluid called a bursa. Bursae (plural of bursa) cushion and lubricate areas where tendons, ligaments, skin, muscles, or bones rub against each other. People who repeat the same movement over and over or who put continued pressure on a joint in their jobs, sports, or daily activities have a greater chance of getting bursitis.
Wearing poorly fitting or constrictive footwear can cause the heel to become irritated and inflamed. Shoes that dig into the back of the heel are the primary cause of retroachilles bursitis. Foot or ankle deformity. A foot or ankle deformity can make it more likely to develop retrocalcaneal bursitis. For example, some people can have an abnormal, prominent shape of the top of their heel, known as a Haglund's deformity. This condition increases the chances of irritating the bursa. A trauma to the affected heel, such as inadvertently striking the back of the heel against a hard object, can cause the bursa to fill with fluid, which in turn can irritate and inflame the bursa's synovial membrane. Even though the body usually reabsorbs the fluid, the membrane may stay inflamed, causing bursitis symptoms.
Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. Pain is typically experienced during activities requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes). Often pain may be worse with rest after these activities (especially that night or the following morning). The pain associated with this condition may 'warm up' with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region.
Carrying out a diagnosis for bursitis is fairly straightforward. The doctor will examine the affected area and ask the patient some questions about his/her recent activities. If the patient has a high temperature the physician may take a small sample of fluid from a bursa near the affected body part. The sample will be tested for bacteria, and perhaps also crystals. If the patient does not get better after treatment the doctor may carry out further tests so that he/she can eliminate the possibility that the symptoms might not be due to something else. These may include an x-ray, to make sure no bones are broken or fractured. Blood tests, to check for rheumatoid arthritis. A CT scan or MRI scan to see if there is a torn tendon.
Non Surgical Treatment
All types of bursitis often can be successfully managed non-surgically, and possible treatments include use of ice packs or compressive dressings, activity modification that may reduce stress or irritation, administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics, corticosteroid injections (knee and elbow), stretching exercises, and/or change of footwear (heel). Surgery may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.