Retrocalcaneal Bursitis

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Retrocalcaneal bursitis is often associated with heel bone spurs and is commonly misdiagnosed as Achilles tendonitis. It is the most common type of heel bursitis.

Here we will look at the common causes, symptoms, diagnosis and treatment options for retrocalcaneal bursitis and how to prevent it from coming back.

What Is Retrocalcaneal Bursitis?

What Causes Retrocalcaneal Bursitis?

The most common causes of retrocalcaneal bursitis are:

• Activities & Over-Training: Frequent, repetitive activities such as jumping and running, particularly uphill, can irritate the bursa leading to micro-trauma and heel bursitis. Sudden increases in training or not adequately warming up before exercise increase the risk of developing retrocalcaneal bursitis.
  
  
• Wearing High Heels: Frequently wearing high heels can lead to shortening of the calf muscles and tightness in the Achilles tendon. When you then wear flat shoes or go barefoot, there is increased tension through the tendon which can cause excessive pressure on the retrocalcaneal bursa leading to inflammation.
  
  
• Wearing Ill-Fitting Shoes: Wearing poorly-fitting or tight shoes that dig in to the back of the heel can irritate the bursa. This is one of the most common causes of heel bursitis.
  
  
• Muscle Tightness: Tightness in the calf muscles can lead to increased tension on the Achilles tendon where it attaches to the heel bone. This places friction on the retrocalcaneal bursa and can cause it to become inflamed. Failing to stretch before playing sports increases the risk of retrocalcaneal bursitis.
  
  
• Bone Spur: A Haglund's Deformity is where a bony lump forms on the back of the heel in response to friction. The bony prominence rubs on the bursa leading to retrocalcaneal bursitis.
  
  
• Medical Conditions: Retrocalcaneal bursitis has be linked with certain medical conditions including gout, arthritis and fibromyalgia.
  
  
• Heel Injury: Sudden impact through the back of the heel such as a fall or being kicked can lead to inflammation of the retrocalcaneal bursa.

Heel Bursitis Symptoms

Retrocalcaneal bursitis symptoms tend to come on gradually over time and get progressively worse, unless there has been a specific injury in which case they tend to develop rapidly.

Heel Bursitis Treatment

Treatment for retrocalcaneal bursitis looks to reduce the pain and swelling as well as the pressure on the bursa and can be divided into four stages:

Phase 1: Looks to treat the pain and inflammation
Phase 2: Looks to restore range of movement and strength at the ankle
Phase 3: Looks to restore function – getting back to the activities you love
Phase 4: Looks at prevent the recurrence of retrocalcaneal bursitis

There will be some overlap in the different phases with certain treatments being beneficial during more than one phase.

In general, the best treatments for retrocalcaneal bursitis are:

1. Rest

Rest is the best place to start with retrocalcaneal bursitis. Resting from any aggravating activities such as running or sports is essential to allow the inflammation in the heel bursa to settle down. Try to avoid any activities that exacerbate your symptoms for a few weeks. If you try to get back to activities too soon, the pain and inflammation will quickly return.

That doesn’t mean you should rest completely. Try different activities such as swimming or cycling and gentle ankle exercises to keep yourself fit and your muscles in good condition without aggravating your retrocalcaneal bursitis. 

2. Regular Ice

3. Medication

You may find it helpful to take painkillers and/or anti-inflammatories to help settle down your symptoms. Always check with your doctor before taking any medications.

4. Orthotics

5. Steroid Injections

Your doctor may advise having a corticosteroid injection to treat heel bursitis. This involves injecting a solution of steroid and local anaesthetic into the bursa to help reduce the pain and inflammation.

It is important to take it easy for 3 days after an injection as it can temporarily weaken the Achilles tendon, making it prone to tearing. You can find out more about how steroid injections work on our sister site.

6. Wear Comfy Shoes

Wear soft-backed, comfortable shoes that don’t rub or place pressure over the bursa at the back of the heel. It may help to wear a shoe with a slight heel to take the tension off the Achilles tendon, but remember to do your calf stretches to alleviate any tightness.

Wearing the right shoes will help both in phase 1 of treatment to reduce pain, and also phase 4 to help reduce the risk of recurrence.

7. Foot Surgery

It is highly unlikely that you would need surgery to treat retrocalcaneal bursitis, but if symptoms have failed to resolve with other treatment methods, or there are secondary problems such as bone spurs, then it may be advised.

Surgery involves removing the retrocalcaneal bursa (known as a bursectomy) and shaving off any underlying bone spurs. 

8. Calf Stretches

9. Exercises For Heel Bursitis

Visit the strengthening exercises section for a whole range of exercises that are suitable and guidance on how to progress them.

10. Returning To Activities

Phase 3 of retrocalcaneal bursitis treatment looks at getting back to full function and being able to return to your usual activities. When returning to sports it is important, as with exercises, to wait until any pain and swelling has completely resolved, which may take a few weeks and to start slowly.

If you try and return to activities too quickly before the heel bursa has been able to fully heal, you will most likely cause a flare up of symptoms and have to start all over again. 

Start by playing for shorter periods, or running shorter distances than usual and gradually build up. Ensure that you warm up and cool down before you exercise. Generally, if you overdo things, you won’t necessarily know about it immediately so don’t be tempted to rush.

A good rule to follow is the 10% rule where you increase activity levels by no more than 10% each week, be that distance or time.

Retrocalcaneal Bursitis Recovery

So how long does it take for retrocalcaneal bursitis to heal? The best way to make a full recovery from heell bursitis is to take it slowly, get the pain and inflammation under control. Then you can gradually start doing stretching and strengthening exercises, building them up appropriately.

Return to sports should not be rushed, but reintroduced slowly, gradually progressing activity levels. If you do this, you should make a full recovery within around three months.

Summary

Retrocalcaneal bursitis is a common cause of pain and swelling at the back of the heel, typically causing a soft lump on the heel. It is typically the result of over-training, tight footwear, foot abnormalities or injury causing inflammation of the heel bursa.

Treatment usually consists of a combination of activity modification, orthotics, steroid injections or medication, appropriate footwear and exercises for heel bursitis. Recovery from retrocalcaneal bursitis typically takes up to three months.

Retrocalcaneal bursitis is not the only cause of pain at the back of the heel. Other common causes include: 

• Achilles Tendonitis: Inflammation and/or degeneration of the achilles tendon of the calf
• Haglund’s Deformity: Bone spur at the back of the heel

Find out about these and other different causes, including how to tell the difference between them, in the heel pain section.

You may also be interested in the following articles:

• Pain On Top Of Foot
• Foot Arch Pain
• Nerve Pain In The Foot
• Burning Foot Pain
• Foot Numbness
• Foot Lumps & Bumps

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Page Last Updated: 23/02/23
Next Review Due: 23/02/25