Heel Bursitis

Heel bursitis (retrocalcaneal bursitis) is a common condition that affects many people globally. This condition is common in people that participate in running activities or activities with frequent repetitive ankle movements. Take a look at our post on the Most Common Causes of Heel Pain After Running.

Pain at the back of the heel can lead to reduced mobility in severe cases. Bursitis occurs as a result of the bursa, which is a fluid-filled sac located at the back of the heel, becoming inflamed usually as a result of over-activity.

Who Is Predisposed to Heel Bursitis?

People who participate in repetitive activity making use of ankle movements are predisposed to developing heel bursitis. Heel bursitis often occurs as a result of too much exercise, too soon leading to inflammation and pain arising in the area. A sudden increase in walking, running, or jumping can lead to inflammation occurring in the bursa. Dancers and figure skaters are prone to this condition as a result of excessive use of the ankle, usually while wearing unsupportive shoes.

Causes of Heel Bursitis

The causes of heel bursitis are usually associated with repetitive ankle movements, seen commonly in athletes and persons that partake in running activities that include jumping. Increasing the intensity and duration of exercise is a common cause of heel bursitis. The repetitive micro-tears occur in the bursa and require time to heal. A sudden increase in loading of the Achilles’ tendon and calf muscles puts strain on the bursa, causing it to become inflamed. Ill-fitting footwear is also a likely contributor to heel bursitis, with aggravation of the bursa due to repetitive rubbing of the shoes onto the heel area. This leads to pain and inflammation in the bursa. 

Uphill running has also been linked as a cause of heel bursitis due to the load and flex placed through the feet. This can lead to irritation of the retrocalcaneal bursae. Dancers and persons partaking in activities with unsupported footwear are at considerable risk to develop this condition. Strenuous training sessions in unsupportive footwear make up a large portion of persons experiencing heel bursitis. Biomechanical abnormalities and tightness in the muscles of the lower leg can predispose someone to develop heel bursitis.

Symptoms of Heel Bursitis

• Swelling at the back of the heel swelling can be noted at the back of the heel as a result of excess fluid accumulation in the bursa associated with heel bursitis. 
• Pain Pain can often be felt at the back of the heel. Pain is usually aggravated by activity and increased load, and lessened by rest. Pain is increased when running or walking uphill. 
• Stiffness in the ankle Swelling or pain in the ankle area can limit ankle movements and restrict the range of motion in the joint. 

How Heel Bursitis Is Diagnosed

Heel bursitis is diagnosed by a medical doctor following a subjective and physical assessment. The doctor may enquire about your current symptoms, the onset of the symptoms, past medical history, and your activity levels. The doctor might also enquire about lifestyle, footwear, and if you’ve attempted various conservative treatments up until this point. 

A physical examination follows, with the doctor examining the foot and ankle for signs of swelling, tenderness, and range of motion. Taking along the shoes you exercise in commonly as this will help the doctor identify if the shoes are the potential cause of your heel bursitis. The doctor may also examine you using active movements of the ankle; asking you to potentially flex your ankles and raise onto the toes while standing. During the assessment, the doctor will rule out any other potential causes of your reported pain, such as fractures or arthritis in the ankle. 

The doctor might opt to do an X-ray to rule out conditions like heel spurs or fractures that could present with similar symptoms as heel bursitis. An MRI can help the doctor identify inflammation in the bursa, and theoretically any other structures around the area. 

Complications Associated With Heel Bursitis

If heel bursitis is left untreated, pain levels may increase to a point where it may limit your ability to walk, run, or complete your daily activities. The range of motion in the ankle may be noticeably reduced as the condition progresses. 

Treatment Options for Heel Bursitis

Rest

Limiting activity that may be aggravating your pain is effective in managing symptoms associated with this condition. When resuming exercise after a period of rest, start slowly with low-intensity exercise and incrementally increase it from there.  

Footwear

Loosely fitting shoes will lessen the risk of retrocalcaneal bursitis occurring. Try to avoid shoes that may rub over the back of the heel. Choosing the best inserts for heel pain will help prevent and reduce it.

Stretching exercises

Stretching the calf muscles will help lengthen the structures that may be contributing to your symptoms. For more information on stretching exercises, take look at our post on Heel Pain When Stretching.

Medication

Nonsteroidal anti-inflammatory medication can be used to manage higher levels of pain that you may be experiencing. These medications come with side effects if used over an extended period.

Ice

Rubbing ice to the painful area will help reduce the inflammation and pain you may be experiencing. Approximately 15 minutes of icing is sufficient in providing pain relief.  

Surgery

In severe cases of this condition, where conservative management options available do not provide relief from your symptoms, surgery can be considered. The surgeon may perform a bursectomy, whereby the inflamed and painful bursa sacs are removed, providing relief from your symptoms. 

For more information on conservative treatment options, take a look at our post A Guide to Treating Heel Bursitis From Home.

How to Reduce Your Risk of Getting Heel Bursitis

One can greatly reduce the risk of developing heel bursitis by slowly increasing the intensity and length of activities that require repetitive ankle movements. Should symptoms of swelling arise after the commencement of the exercise, reduce the exercise further and continue with the conservative treatment options mentioned above. Taking a look at the shoes you are wearing daily and during exercise can help determine the potential cause of heel bursitis. Lessening the potential risk of developing this condition through wearing loose-fitting shoes will benefit you greatly. 

Should you not find relief from conservative treatment options, consult with a medical professional regarding other treatment options that can be used to manage this condition.