In your heel, there is a sac filled with fluid known as a bursa. It is located under your Achilles tendon at the back of your heel bone. Many of your large joints have a bursa around them. They
provide cushioning and lubrication for the tendons, muscles and bone. Bursitis of the heel occurs when the bursa in your ankle becomes swollen.
The most common causative organism is Staphylococcus aureus (80% of cases), followed by streptococci. However, many other organisms have been implicated in septic bursitis, including mycobacteria
(both tuberculous and nontuberculous strains), fungi (Candida), and algae (Prototheca wickerhamii). Factors predisposing to infection include diabetes mellitus, steroid therapy, uremia, alcoholism,
skin disease, and trauma. A history of noninfectious inflammation of the bursa also increases the risk of septic bursitis.
The following are the most common symptoms of bursitis. However, each individual may experience symptoms differently. Bursitis can cause pain, localized tenderness, and limited motion. Swelling and
redness may occur if the inflamed bursa is close to the surface (superficial). Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness, which may lead to the deterioration of
muscles and a limited range of motion. The symptoms of bursitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
If heel pain has not responded to home treatment, X-rays may be ordered. These images can show deformities of the heel bone and bone spurs that have developed at the attachment of the Achilles. If
there is swelling and/or pain that is slightly higher and within the Achilles tendon itself, an MRI may be ordered to determine if the tendon is simply inflamed or if there is a chronic tear on the
tendon. Aspiration and lab tests. If a septic bursitis is highly suspected, a doctor may perform an aspiration, removing fluid from the bursa with a needle and syringe. In addition to relieving
pressure and making the patient more comfortable, it provides a fluid sample that can be tested for infection.
Non Surgical Treatment
The patient with retrocalcaneal bursitis should be instructed to apply ice to the posterior heel and ankle in the acute period of the bursitis. Icing can be performed several times a day, for 15-20
minutes each. Some clinicians also advocate the use of contrast baths. Gradual progressive stretching of the Achilles tendon may help relieve impingement on the subtendinous bursa and can be
performed in the following manner. Stand in front of a wall, with the affected foot flat on the floor. Lean forward toward the wall until a gentle stretching is felt within the ipsilateral Achilles
tendon. Maintain the stretch for 20-60 seconds and then relax. Perform the stretches with the knee extended and then again with the knee flexed. To maximize the benefit of the stretching program,
repeat the above steps for several stretches per set, several times daily. Avoid ballistic (ie, abrupt, jerking) stretches. Other treatment options are microcurrent therapy and corticosteriod
injection into the retrocalcaneal bursa. If conservation treatment fails then surgery is indicated.
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help
To prevent bursitis of the heel in the first place, always keep proper form during exercise. In addition, don?t jump into exercises that are too intense without building up to them. Strengthen and
flex your ankle.