Bursitis

What is Bursitis?

Bursitis is an inflammation of a bursa. The heel has three areas that are involved in bursitis:

1. Retrocalcaneal Bursa which is located between the Achilles tendon and heel bone
2. Subcutaneous calcaneal bursa which is located between the skin and where the Achilles tendon attaches to the heel bone
3. Plantar-calcaneal bursitis is located between the heel bone and the plantar fascia (thick fibrous tissue that inserts into the heel bone)

Cause

• Repetitive overuse injury of the ankle during long periods of running and or walking
• Tight shoes
• The heel counter of the shoe constantly rubbing against the back of the heel
• Wearing shoes with a low cut heel counter
• Abnormal foot mechanics (abnormal pronation)
• Poor flexibility
• Inappropriate training

Signs and Symptoms

• Swelling, redness and pain in the region of the bursa
• Walking on the toes or forefoot will intensify the pain at the back of the heel
• Painful limp
• Warmth over the skin and tissue

Treatments

• Gradual and progressive stretching of the Achilles tendon
• Exercises to strengthen and support the ankle
• Rest or reduced weight bearing activities
• Immobilisation in a cast for 4-6 weeks for severe cases
• Ice
• Proper fitting and supportive footwear
• Massage
• Joint mobilisation
• Anti-inflammatory medications: only if this does not have adverse results with the patient's current medication
• Heel pads and heel lifts
• Footwear Advice
• Strapping and padding Orthoses/innersoles. The orthotics prescribed and designed by the podiatrists at the Heel and Arch Pain Clinic (affiliated with Beyond Podiatry) are made to align the foot in the correct posture
• Surgery is indicated in severe cases when conservative treatment has not resolved the problem