Retrocalcaneal Bursitis

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Retrocalcaneal Bursitis is a common condition in athletes, particularly runners. It can often be mistaken for Achilles tendinitis or can also occur in conjunction with Achilles tendinitis. A bursa is a small sack of fluid that goes between a tendon and a bone to help the tendon move smoothly over the bone. The retrocalcaneal bursa lies between the Achilles tendon and the heel bone. With repeated trauma the bursa can become inflammed. This injury is often mistaken for Achilles tendinitis. It is possible for the athlete to have both Achilles tendinitis and bursitis at the same time (Haglund's syndrome).


  • Pain at the back of the heel especially when running uphill or on soft surfaces.
  • Tenderness and swelling which might make it difficult to wear certain shoes.
  • When pressing fingers in both sides of the heel a spongy resistance may be felt.

  • Causes:
  • Poor biomechanics.
  • Hill running or stair climbing.
  • Overuse resulting from the natural lack of flexibility in the calf muscles.
  • Rapidly increasing mileage or speed.
  • Starting up too quickly after a layoff.
  • Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort such as in a final sprint.
  • Tight muscle groups in the back of the leg
  • Irritation from the heel counter of a sports shoe

  • Treatment:
    The initial treatment for retrocalcaneal bursitis is to avoid activities that cause pain and take non-steroidal anti-inflammatory medications (for example, ibuprofen). Your doctor may recommend icing the heel several times a day and may prescribe physical therapy to improve flexibility and strength around the ankle. Physical therapy serves two functions; it can help the bursitis improve and it can help prevent future recurrences.

    Over-the-counter or custom heel wedges may help to decrease the stress placed on the attachment of the Achilles tendon and the associated bursa.

    If these interventions are ineffective, then some health care providers may inject a small amount of steroids into the bursa. If the condition is associated with Achilles tendonitis, then casting the ankle to prevent motion for several weeks can be effective. Very rarely, surgery may be necessary to remove the inflamed bursa.

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