Bursitis is the inflammation of the small fluid-filled pads, or bursae, that act as cushions among your bones and the tendons and muscles near your joints. Bursitis occurs when the bursa become
inflamed, and often occurs in joints that perform frequent and repetitive motion. The foot only contains one naturally occurring bursal sac between the Achilles tendon and the heel bone, which
protects the Achilles from the pressure against the heel bone during ambulation. However, shoes may put pressure on this bursa. The bursa might also incur trauma from walking on hard ground. And,
though they are not naturally occurring, bursa sacs can also form, and become inflamed, in other parts of the foot, including the bottom of the heel, and the metatarsal plate, the outside of the foot
below the fifth toe, and so on.
Although rare, bursitis also may be caused by an infection, known as septic bursitis. This is a serious medical condition that requires antibiotics to treat the infection and prevent its spread to
other points in the body or the bloodstream. Septic bursitis may cause the back of the ankle to become red or hot. The person may also get the chills or fever and may feel sick and tired. Typically
this type of bursitis would be suspected if there has been any history of an open wound in the area, such as a blister.
Nagging ache and swelling in or around a joint. Painful and restricted movement in the affected joint. Pain radiating into the neck or arms when bursitis strikes the shoulder (the most common site).
Fever, when associated with an infection.
Your doctor will take a history to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will
look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the achilles tendon over the inflamed bursa.
Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the achilles tendon to the heel bone. Imaging studies such as X-ray and MRI are not usually necessary at
first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.
Non Surgical Treatment
Despite appropriate physiotherapy management, some patients with retrocalcaneal bursitis do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best
course of management. This may include further investigations such as an ultrasound, X-Ray, MRI or CT scan, pharmaceutical intervention, corticosteroid and anaesthetic injection into the
retrocalcaneal bursa, draining of the bursa, or review by a specialist or podiatrist who can advise on any treatment that may be appropriate to improve the condition.
Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a
pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle
or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be
underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).
Maintain proper form when exercising, good flexibility, and strength around the ankle to help prevent this condition from arising. Proper stretching of the achilles tendon helps prevent injury.