05 Feb Retrocalcaneal Bursitis
Retrocalcaneal bursitis is the inflammation of the small fluid-filled sac (bursa) located between the back of the heel bone and the Achilles tendon. It is also called the Achilles bursitis. It clinically presents as swelling, tenderness, and pain on the back of the foot. Symptoms include pain at the back of the heel, especially when running uphill, which may get worse when rising on the toes (standing on tiptoes). There is also tenderness and swelling at the back of the heel. The symptoms typically improve with rest.
It develops gradually from chronic pressure from the back of a shoe. Repetitive upward overflexion of the foot causes the Achilles tendon to press against the bursa and the irritation eventually leads to inflammation. Pre-existing conditions, such as having the Haglund deformity or an altered joint axis, predispose to its development. Furthermore, it may also be associated with conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies.
Clinical diagnosis is based on a careful history and evaluation of the tendon, bursa, and calcaneum by examination of the region for bony prominence and local swelling as well as tenderness. Imaging may be performed as needed. Plain radiographs of the calcaneus may reveal a Haglund deformity (increased prominence of the posterosuperior aspect of the calcaneus). Magnetic resonance imaging (MRI) may demonstrate bursal inflammation, but it is not necessary for diagnosis. Ultrasonography may sometimes be useful for diagnosing pathologies of the Achilles tendon.
There are a few steps that can be taken to avoid developing retrocalcaneal bursitis, including stretching and warming up before working out, wearing supportive shoes, strengthening foot muscles, etc.
Conservative management of this condition includes changing footwear if needed, ice massage, and non-steroidal anti-inflammatory drug (NSAID) treatment. Once developed, retrocalcaneal bursitis symptoms usually improve in 1-2 months with home treatment. One must avoid uphill running but low-impact activity, such as swimming is permissible.
There will be some patients who will not respond to the conventional treatment for retrocalcaneal bursitis, most of them have the underlying Haglund’s deformity described above. For these patients, the only option left is surgical. Adequate bony resection is required for a successful outcome as it allows for decompression of the tendon and the retrocalcaneal bursa. A two-step calcaneal ostectomy procedure can be performed to remove the dorsal and posterior prominences in order to provide symptomatic pain relief. A tendon-splitting procedure allows good observation for adequate resection of the periosteum on the medial and lateral sides of the calcaneus and of the tendon, which a unilateral approach does not. And these patients returned to normal function more quickly than patients who had the lateral approach.
Overall, retrocalcaneal bursitis is an inflammatory condition brought on by overuse of the retrocalcaneal/Achilles bursa leading to inflammation, which requires rest and mostly responds well to conservative management, but requires surgical treatment when there is an underlying Haglund deformity.