A bursa is a fluid-filled sac. There are hundreds of deep and superficial bursae throughout the human body. They are typically located near major joints. Bursae are situated between bone and soft
tissues like tendons, ligaments, muscles, and skin. They serve as a cushioning pad to absorb shock. The fluid within the sac is secreted to assist with friction-free movement as the soft tissues move
across a bony area.
Causes of bursitis can be from any form of friction between bone and the soft tissues. The most common cause is due to abnormal pronation.
Posterior heel pain is the chief complaint in individuals with calcaneal bursitis. Patients may report limping caused by the posterior heel pain. Some individuals may also report an obvious swelling
(eg, a pump bump, a term that presumably comes from the swelling's association with high-heeled shoes or pumps). The condition may be unilateral or bilateral. Symptoms are often worse when the
patient first begins an activity after rest.
Your doctor will check for bursitis by asking questions about your past health and recent activities and by examining the area. If your symptoms are severe or get worse even after treatment, you may
need other tests. Your doctor may drain fluid from the bursa through a needle (aspiration) and test it for infection. Or you may need X-rays, an MRI, or an ultrasound.
Non Surgical Treatment
The initial treatment for retrocalcaneal bursitis is to avoid activities that cause pain and take non-steroidal anti-inflammatory medications (for example, ibruprofen). Your doctor may recommend
icing the heel several times a day and may prescribe physical therapy to improve flexibility and strength around the ankle. Physical therapy serves two functions, it can help the bursitis improve and
it can help prevent future recurrences.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be
effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat
another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any
bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around
the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis
symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.