Managing Retrocalcaneal Bursitis: Causes, Symptoms, and Treatment Options

Introduction:

The bursa, also known as bursas or bursae for the plural form, is a vitally important thin sac filled with lubricating fluid that is situated between bone and surrounding soft tissue, bones, tendons, and/or muscles around joints. Bursas are beneficial to the human body because they lessen tension and the negative effects of wear and tear at points of friction and allow for resistance-free movement by the body. The majority of bursae in the human body are synovial bursae, which are characterized as thin, synovial membrane sacs and are particularly prevalent around major joints in the extremities. The calcaneus bone and the Achilles tendon are both located above the retrocalcaneal bursa, which is located near the rear of the heel. It is more likely to become inflamed due to its location near regions of weight bearing and repeated motion, which is referred to as retrocalcaneal bursitis.

What Is Retrocalcaneal Bursitis?

During joint movement, tendons, ligaments, muscles, and skin must glide across bones. This gliding action is made possible by bursae, which are tiny, fluid-filled sacs that act as a thin cushion and reduce friction between the surfaces. The medical term for an inflamed and irritated bursa is bursitis. In the joints that experience regular repetitive action, bursitis frequently develops. Inflammation of the bursa between the heel bone and the anterior surface of the Achilles tendon is known as retrocalcaneal bursitis. The tight band of fibrous tissue known as the Achilles tendon attaches the calf muscles to the heel bone (calcaneus). The calcaneal tendon is another name for the Achilles tendon. The Achilles tendon is the largest and strongest tendon in the human body. The Achilles tendon pulls on the heel when the calf muscles contract. When walking, running, or leaping, we may stand on our toes owing to this motion. The Achilles tendon is strong, but because of its poor blood flow and the intense strains imposed on it, it is also prone to damage.

What Are the Signs and Symptoms of Retrocalcaneal Bursitis?

Severe heel pain and swelling are the most prevalent and prominent signs of retrocalcaneal bursitis. It's possible that merely applying pressure to the heel can cause pain. Additionally, touching the heel could cause some soreness. Shoes that are too tight may be uncomfortable to wear. When flexing the foot, a crackling sound occasionally can be heard.

Other symptoms may include

• Running or walking causes a sudden, shooting pain in the calf muscles and heel.

• It is difficult to fully bend or straighten the ankle because of stiffness.

• Redness or warmth on the heel's back of the skin

• A firm bump behind the heel might be a sign of swelling.

• The pain worsened by activity and at night.

What Are the Causes of Retrocalcaneal Bursitis?

Overuse from excessive walking, running, or jumping, i.e., frequent use of the ankle. Additionally, people who exercise or run in tight-fitting shoes without adequately warming up or stretching worsen the condition. A condition like arthritis or an infection is an example of additional causes. Retrocalcaneal bursitis may progress to a chronic condition, if ignored and untreated.

What Are the Risk Factors for Retrocalcaneal Bursitis?

• Age.

• Overuse injury.

• High-impact sports activities such as rock climbing.

• Poor stretching before exercise.

• Tight Muscles: It may put additional strain on the bursa and may cause pain.

Other conditions may increase the risk of retrocalcaneal bursitis.

• Foot or ankle deformity which may cause extra friction leading to bursitis.

• Rheumatoid arthritis.

• Trauma to the heel leads to the bursa filling with fluid or blood and becoming inflamed.

• Ankylosing spondylitis.

• Gout - the urate crystals may deposit in and around the bursa and cause an increased risk of bursitis.

How Is Retrocalcaneal Bursitis Diagnosed?

Physical Assessments:

• To rule out other possible causes of heel pain, such as plantar fasciitis and Achilles tendinitis.

• To note swelling, tenderness on palpation and pain points, and range of motion.

Obtaining Medical History:

• To assess any medical conditions that can cause inflammation.

• In some instances, if the heel pain has not responded to first-line treatments, the following may also be done:

X-Ray: To rule out fractures or any other abnormalities of the heel bone such as bone spurs.

Blood Tests: To check for inflammatory conditions.

MRI (Magnetic Resonance Imaging) or Ultrasound: To check for soft tissue pathologies such as Achilles tendonitis.

Bursal Aspiration: Fluid aspiration from the bursa under local anesthesia to rule out infection or sepsis. The aspirated fluid is checked for the presence of bacteria, blood cells count, and glucose level.

How Can Retrocalcaneal Bursitis Be Treated?

The location of the inflamed sac, the intensity of the inflammatory reaction, and the duration of the condition all affect the type of treatment needed for bursitis.

• Prescription or Over-The-Counter Medicines: This include Ibuprofen, Aspirin, and Naproxen are NSAIDs (non-steroidal anti-inflammatory medications). These aid in reducing swelling and discomfort. The back of the heel's swelling and soreness should subside with treatment in two to three weeks.

• Rest: One might need to change or cut back on activities that hurt the heels. These include strenuous exercises like jogging. Rest, a switch in shoes, applying ice to the back of the heel, and modest Achilles tendon stretches are all possible at-home treatments. To protect the skin during icing, one can wrap the ice with a towel.

• Footwear: An appointment with the health care physician, a podiatrist, or an orthopedist is indicated if the symptoms do not significantly improve after two to three weeks of home therapy. To lessen stress on the bursa, they could suggest physical therapy or shoe orthotics. People affected should stay away from wearing shoes that are too tight or irritate the heel. Clogs and other footwear accessories such as shoe cushioning or inserts with open-back heels may be beneficial. Moving around can be made more comfortable by accessories like heel cups or padding for the back of the heel.

• Stretching Exercises: The ankle and foot can regain flexibility with a few gentle stretching exercises. They can alleviate discomfort as well.

• Steroid Injection: A painkiller and steroid are injected with a needle into the injured bursa. For several weeks following the injection, discomfort, and edema might be reduced.

• Surgery: Unless other treatments fail, surgery is not frequently required.

Conclusion:

Bursa is a vitally important structure with a thin sac containing fluid effective in reducing tension and preventing wear-and-tear effects. Fortunately, bursitis (inflammation of the bursa) is typically preventable. The healthcare provider can assist the person in locating remedies that will speed up the healing of the inflamed bursae and ways to avoid developing bursitis in the future. Remain in bed for as long as the doctor advises one to rest. One can lessen the risk and the intensity of flare-ups by altering the way one does certain activities.