Heel Bursitis is a condition that results from an inflammation of a fluid-filled sac (Bursa) that forms under, around, or at the back of the heel bone at the point where the Achilles tendon intersects with the heel. More pain is experienced at the back or center of the hill bone and becomes significantly more painful during the day.
A bursa is a fluid-filled sac that usually cushions joints, tendons, or muscles. They have a lubricating effect on areas where joints, tissues, and muscles meet. They reduce the friction effect during movement.
When the bursae become inflamed, the condition is called bursitis. Inflammation of the bursae may cause pain and discomfort, and limit your ability to move the affected joints.
The only naturally occurring bursa sac in the foot is located between the Achilles tendon and the heel bone (calcaneus). However, due to the occurrence of many “micro-trauma” that our feet experience, the body generates more bursal sacs to protect the joints upon which the trauma has occurred. If the trauma continues to occur, the bursa sac may become inflamed and the patient suffers from bursitis.
Bursitis occurs in three main types. They include Subcutaneous (or Achilles) bursitis Retro-calcaneal bursitis, and Sub-calcaneal (or Plantar Calcaneal) bursitis.
These types of bursa are located between the Achilles tendon and the heel bone.
Subcutaneous Calcaneal Bursa
Subcutaneous calcaneus bursa normally occurs between the skin and the point where the heel bone and Achilles tendon attach.
Sub-Calcaneal Bursa (Plantar Calcaneal Bursitis)
It is also called plantar calcaneal bursitis. The bursae occur between the hill bone and a thick fibrous tissue inserting into the heel bone called the fascia. The symptoms of this condition resemble those of plantar fasciitis. An athlete will notice a dull ache under his heel at the point directly under the fat pad. However, the pain in sub-calcaneal bursa is felt majorly more at the centre than in plantar fasciitis also called heel spur. The pain becomes significantly worse during the day.
Causes of Heel Bursitis
- Repetitive overuse
- Injury of the ankle when running, walking, or any other physical activity.
- Tight shoes.
- Putting on shoes that have a low-cut heel counter.
- Abnormal pronation/ foot mechanism.
- Inappropriate training.
- Poor flexibility.
Treatment for Heel Bursitis
- Put on supportive and comfortable shoes. Supportive footwear can help to minimise friction at the back of your heel caused by tight footwear. Shoes that have the Achilles notch or groove at the collar can help to prevent or reduce friction with the Achilles tendon (close to all shoes for exercise have the Achille’s notch).
- Rest. Resting the foot frequently helps to reduce inflammation. The R.I.C.E formula, which stands for rest, ice, compression, and lastly elevation is recommended by most health practitioners. Before continuing with any activities, it is important for you to wait until you no longer feel any pain or swelling at the back of your foot. It may normally take some weeks before healing completely but after that, the patient may return to his or her normal activities gradually to the level as before the symptoms began.
- Going back to normal activities, especially ones that cause friction may make the symptoms to flare up before healing.
- Orthotics help in enhancing biomechanics, gait, and reduce irritations of the rectal calcaneal bursa. For optimal results, it is important to carry out proper gait assessment and evaluation.
- Stretching and physical therapy. Stretching of the Achilles tendon may help to alleviate pain. It is important to carry on the stretching exercise even when the pain is no longer felt. This will help to reduce recurrence of the same problem.
- Padding and Strapping. Strapping helps to reduce friction and rubbing, and provide pressure relief over the affected area.
- Topical and oral anti-inflammatory medications.
- Lidocaine patches are sometimes helpful. Physicians can also prescribe topical and oral NSAIDs.
- Aspiration. Removing fluid from swollen bursa using a syringe can also help to release some pressure.
- Injection Therapy. Some forms of injection therapy such as prolotherapy may also help in such cases, although they are rarely used. A short period of mobilisation is often recommended as a precaution before the injection to protect the attachment of the Achilles tendon.
- Shock wave therapy – transmitted through the skin may also enhance blood flow and stimulate healing. This process takes place in a physical therapist’s office and patients often don’t feel any pain.
- Antibiotics – Antibiotics are only used to treat specific bursitis. The microorganism that is causing the infection might influence the type of antibiotic that will be used. Oral antibiotics effectively lead to healing among patients of septic bursitis. More challenging cases may require hospitalisation and intravenous injection of antibiotics.
- Surgery. Some cases of retrocalcaneal bursitis may require bursectomy. In this case, the bursa is removed surgically from the back of the ankle. Since the site has many bones, surgery may result into complications like healing problems at the incision point. However, such cases that need surgery are very rare.
- Contact us on 03 9077 5915 for further assessment and treatment.