What are the other Names for this Condition? (Also known as/Synonyms)

• Retrocalcaneal Bursitis
• Heel Bursitis

What is Bursitis of the Heel? (Definition/Background Information)

• Bursitis is a painful condition caused by inflammation of the bursa. Bursitis of the Heel affects the heel bone, at the back of the foot. It develops from an injury to the heel bursa or to the ankle
• A bursa is characterized as a fluid–filled sac that acts as a cushion, to help the muscles, ligaments, and tendons, glide easily over the bones. Bursae are located throughout the body, such as the elbow, knee, shoulder, and hip; bursitis may involve any bone or joint in the body
• This inflammatory usually condition develops from a set of repetitive movements involving the bursa, such as prolonged jumping or jogging, resulting in overuse or trauma to the heel bone. Other underlying conditions, such as gout or infection, may adversely affect Heel Bursitis
• The treatment measures for Bursitis of the Heel include both nonsurgical methods, such as resting the injured area, medications, or applying compression bandages, and surgical methods that include incision and fluid drainage, or an arthroscopic bursectomy
• The prognosis for Bursitis of the Heel depends on the severity of the condition; but, it is generally good with adequate treatment. However, some cases do not improve even after a year and may require surgical interventions

Who gets Bursitis of the Heel? (Age and Sex Distribution)

• Bursitis of the Heel may occur in individuals of all ages, races, ethnic groups, and gender
• Heel Bursitis may be more common in individuals participating in sporting activities that involve a lot of walking or running

What are the Risk Factors for Bursitis of the Heel? (Predisposing Factors)

Common risk factors associated with Bursitis of the Heel may include:

• Repetitive stress on the bone/joint associated with athletic sports (such as track and field events), or certain occupations (such as farming or construction activities), and hobbies, can increase the risk of developing Heel Bursitis
• Intense physical activity or exercising; sudden change in one’s exercise regimen or activity level
• Traumatic injuries or fall injuries that affect the feet or ankles
• Excess body weight associated with obesity, which increases stress on the foot joints
• Chronic inflammatory disorder such as rheumatoid arthritis
• Arthritis and gout
• Prosthetic implants causing irritation of the bursa; use of poorly-fitting footwear
• Bone spurs or calcium deposits, which develop within the tendons, may cause irritation of the bursa
• Diabetes type I: High blood glucose levels that result from an insulin secretion deficiency
• Diseases or disorders affecting the thyroid gland are known to increase the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Bursitis of the Heel? (Etiology)

Bursitis of the Heel, causing swelling in the bursa with redness and pain, usually develops from repetitive stress and overuse of the heel bone or joint. There are a variety of factors that may result in bursitis and these include:

• Repetitive stress on the bone or joint, due to certain sports or occupation-related stress; mostly from sports that involve a lot of jumping, skipping, running, or jogging
• Bacterial infection of the bursa
• Chronic inflammatory disorder (such as rheumatoid arthritis)
• Gout: A medical condition caused by a high level of uric acid in blood
• Past surgery involving the heel bone/joint

What are the Signs and Symptoms of Bursitis of the Heel?

The signs and symptoms of Heel Bursitis may include:

• Swelling and redness in the heel or foot
• The retrocalcaneal bursa is most commonly affected
• Noticeable pain, pain on touch or while applying pressure on the foot
• Standing on one’s toes or bending the foot back and forth may result in severe pain
• Decreased range of joint movement
• The symptoms may develop slowly over weeks and months

Bursitis of the Heel may resemble Achilles tendinitis and it may be misdiagnosed.

How is Bursitis of the Heel Diagnosed?

Diagnostic methods that a physician may use to help diagnose Bursitis of the Heel include:

• Physical examination: A physician will perform a thorough physical examination to determine, if the individual has bursitis. In addition to this, a complete medical history can aid in arriving at a diagnosis
• X-ray of the heel: This imaging tool is not helpful in determining a diagnosis of the Heel Bursitis. However, it may aid in ruling out other possible causes for pain and discomfort, such as growth of bone spurs, etc.
• Blood test: A blood test is a routine test used to diagnose various disease and conditions. The blood sample drawn is taken to a laboratory for analysis, to test for any signs of any infection. It is also helpful in evaluating the cause of bursitis such as rheumatoid arthritis
• Joint fluid culture: A needle is used to drain fluid from within the heel bursa. The fluid sample is then taken to a laboratory for analysis. Removal of the bursa fluid may also help relieve the symptoms
• Magnetic resonance imaging (MRI) of the affected heel: An MRI is a more detailed scan that uses radio waves and a magnetic field to produce images that allow a physician diagnose the severity of bursitis
• Ultrasound imaging of the affected foot: In this imaging scan method, high-frequency sound waves are used to generate a more detailed image of the involved region

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Bursitis of the Heel?

The complications of Bursitis of the Heel depend on the region affected and may include:

• Longstanding pain and swelling of the joint resulting in chronic Heel Bursitis
• Presence of tendinitis (inflammation of the tendon at the location)
• Walking difficulties, limping
• Treatment side effects

How is Bursitis of the Heel Treated?

A majority of the individuals, who develop Bursitis of the Heel, seldom require a surgery; in others, surgery may be necessary.

Nonsurgical treatment measures include:

• Any activity that aggravates the heel injury further should be avoided. The physician may advise the individual to refrain from participating in any physical activity, till the pain or symptoms get better
• Applying ice or a damp heated towel to the region can help reduce pain and swelling
• Non-steroidal anti-inflammatory oral medications, such as Ibuprofen and naproxen, can help reduce the pain and swelling
• Corticosteroid injections to the affected heel
• Undertaking treatment of any underlying condition causing bursitis
• Suitable physical therapy to address the heel condition

Surgical treatments are usually undertaken, if improvement of the condition is not noted even after 6-12 months. The treatment measures may include:

• Incision and drainage of the infected bursa: Incision and drainage is a minimally-invasive surgical procedure that involves the drainage of fluid, which has build-up in the infected bursa. This surgical procedure is performed under a general anesthetic
• Arthroscopic bursectomy: It is a minimally-invasive surgical procedure that is used to remove the infected bursa, using an orthopedic device and a tiny camera, called an arthroscope. This instrument is inserted through a tiny incision around the region and the infected bursa removed

How can Bursitis of the Heel be Prevented?

To prevent Bursitis of the Heel, individuals should be careful and consciously aware while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study, or play. Any possible dangers should also be anticipated and appropriate safety measures adopted.

A few ways to further help prevent unwanted injuries or Heel Bursitis include:

• Avoid any sports or activities that put too much repetitive stress on the bone/joint
• Warm up before starting any new physical activity
• Maintain flexibility and strength of the joints by performing certain basic exercises
• Maintain an active lifestyle to avoid weight gain
• Maintain good posture while sitting, standing, or walking
• Undertaking a proper treatment of type I diabetes, rheumatoid arthritis, or gout, can help prevent bursitis

What is the Prognosis of Bursitis of the Heel? (Outcomes/Resolutions)

• The long term prognosis of Heel Bursitis is usually good in a majority of the individuals
• A high percentage of individuals with an affected bursa sac regain their full strength and range of motion within a few weeks of surgery

Additional and Relevant Useful Information for Bursitis of the Heel:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/