Bursitis of the heel

Heel bursitis (calcaneal bursitis) is the inflammation of the bursa (retrocalcaneal bursa) behind and below the heel, which fills with fluid and becomes thicker and presses on surrounding structures, causing pain.

The fluid-filled sacs are designed to reduce friction between tendons and bones and distribute the load evenly over the joint.

 The heel bursa (bursa retrocalcanei) is located in the rear heel area, between the heel bone and the Achilles tendon.

In the case of heel bursitis (calcaneal bursitis), a bursa becomes inflamed, which then swells and thus increases in volume.
The heel is a bone that plays a fundamental role in the dynamics of walking because it is the first to hit the ground and transmits body weight to the ground.
Hallux valgus can lead to bursitis in the big toe area.

There are different types of bursitis :

  • physical in nature when caused by overload or excessive friction of surrounding structures;
  • chemical in nature when triggered by substances originating from inflammatory and degenerative processes of the tendons;
  • septic when caused by bacteria, such as the staphylococci;
  • hemorrhagic when caused by external violence causing the sac to fill with blood.


What are the causes of calcaneal bursitis?

The most common causes of bursitis are trauma, especially in the heel area; among the patients are many athletes who have suffered ankle sprains or bruises .
The likelihood of heel bursitis occurring on the left or right side is about the same.
Athletes who run a lot, such as soccer players, joggers, marathon runners, walkers, handball, volleyball, basketball, rugby, American football players, etc., can develop bursitis from constant tendon friction caused by ankle movement.
If the sport is practiced on hard surfaces, the heel is forced to act unnaturally because it has difficulty absorbing the impact of running and changing direction.

Changing shoes can overload the Achilles tendon ; high heels keep the tendon short and relaxed, while sneakers or flat shoes stretch the Achilles tendon; it can lead to inflammation of the bursa when switching from heeled to heeled shoes.

Shoes that are too wide, loosely tied or unlaced, which young people often wear, can also cause friction in the rear heel area, which can lead to bursitis.
Casual athletes can develop heel bursitis from subjecting an untrained tendon to loads it is not used to.
Rheumatic diseases can also cause heel bursitis; this includes:

What are the symptoms of calcaneal bursitis?

People who suffer from heel bursitis have pain when walking, when moving the ankle in general (even without weight bearing) and when pressing on the affected area; in severe cases, the pain can be unbearable. The complaints occur in the rear and upper heel area and are mainly noticeable when walking and running. If the bursitis is the result of trauma, the pain can also occur without exertion, for example when lying down. The stretching of the three-headed calf muscle leads to tension in the Achilles tendon and can cause painful stitches in the case of an existing bursitis.

How is the diagnosis made?

In order to diagnose heel bursitis, a musculoskeletal ultrasound of the foot should be performed, which will show thickening of the bursa in the rear of the heel.
The doctor will look for typical signs and symptoms and, after listening to the medical history, will decide whether the discomfort is due to the bursa or other foot disorders.

What can you do? Which therapy is suitable?

Every aspect of calcaneal bursitis caused by inflammation must be treated: relapses must be prevented, the inflammation must heal and the causes of the disease must be eliminated.
In the acute phase, ice can be used (10 minutes, at least 3 times a day), but only to relieve pain temporarily.
An athlete who has overloaded the heel and Achilles tendon must take it easy for a short time and then correct their footwear, change the surface or use shoe inserts to make the foot strike more homogeneous.
An ointment with a natural anti-inflammatory , such as arnica, can help relieve symptoms and encourage the foot to slide freely in the shoe.
If these measures are insufficient, the physiatrist will decide whether drug treatment based on anti-inflammatory drugs and infiltrations or physiotherapeutic treatment makes sense.

If it is a post-traumatic condition, special attention will be paid to the inflammation and anatomical changes suffered by the bones of the foot; in fact, trauma can shift the position of the heel in relation to the ankle bone or tibia and fibula.
Even a slight displacement can change how the bones slide among themselves and keep the inflammation alive.

If the bursitis lasts longer, the general practitioner or a specialist (physiatrist or orthopaedist) should be consulted, who will decide whether anti-inflammatory drugs or physical therapies (eg shock waves) and manual therapies should be used.

Natural remedies also include returning to your old shoes if the bursitis was triggered by changing shoes.
If the cause of chronic bursitis is a rheumatic disease, e.g. B. gout, the responsible specialist is a rheumatologist who can recommend a special diet and pharmacological treatment.

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