Achilles Tendon Bursitis vs. Achilles Tendonitis: Similarities and Differences

Heel pain is a commonly reported symptom in people with foot pain. Pain can occur on the underside of the heel or towards the back of the heel. If left untreated, heel pain can progressively get worse and may take longer to heal. Heel pain rarely requires surgery to relieve symptoms. 

What Is Achilles Tendon Bursitis? 

Achilles tendon bursitis is inflammation arising from the bursa or fluid-filled sac between the heel and the Achilles tendon. The bursa contains a lubricating fluid that reduces friction between the bones and the Achilles tendon. The Achilles tendon connects the calf muscle to the heel bone where the force is distributed around the heel as needed for walking, running, or jumping. The causes of Achilles tendon bursitis include excessive running, jumping, and walking. Tight-fitting shoes can aggravate symptoms. This condition is linked to and often mistaken for Achilles tendonitis.

Symptoms of Achilles Tendon Bursitis:

• Pain at the back of the heel,  especially while walking, running, or jumping
• Worsened by raising onto the toes when standing
• Red or inflamed skin around the heel
• Pain when touching the back of the heel
• Reduced ability to walk or run 
• Swelling in the foot or ankle

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What Is Achilles Tendonitis?

Achilles tendonitis is a common condition causing pain and inflammation in the Achilles tendon, which connects the calf muscle to the foot. The Achilles tendon becomes aggravated and inflamed usually due to overuse of the ankle. Pain is usually felt on the tendon above the heel where the Achilles tendon comes down toward the heel. 

Symptoms of Achilles tendonitis:

• Pain and stiffness felt in the Achilles tendon above the heel itself
• Pain felt at the Achilles tendon that worsens with activity 
• Pain worsens after activity or the next day
• Swelling in the heel 
• Pain on the heel when wearing shoes 

Achilles tendonitis can be caused by an increase in the duration and intensity of exercise or activity. Other causes include shortened calf muscles, which increase the tension placed on the Achilles tendon while exercising, and Haglund’s deformity, which is a bony abnormality in the heel that aggravates the tendon running over it.  

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How to Diagnose Achilles Tendon Bursitis or Achilles Tendonitis

Achilles tendonitis is characterized by stiffness and pain over the tendon slightly about the heel bone when the foot or toes are pushed down. Mild swelling above the heel bone on the tendon is noted and is usually worsened with activity in Achilles tendonitis. Achilles tendon bursitis is characterized by pain worsening with activity and symptoms that improve with rest. The pain associated with Achilles tendon bursitis is usually lower down on the heel than Achilles tendonitis.

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