There are about 160 bursae in the human body. These little, fluid-filled sacs cushion pressure and lubricate points between our bones, tendons, and muscles near our joints. The bursae are lined with synovial cells. Synovial cells produce a lubricant that reduces friction. This cushioning and lubrication allows our joints to move easily. When a person has bursitis, inflammation of the bursa, movement or pressure is painful. Overuse, injury and sometimes an infection from gout or rheumatoid arthritis may cause bursitis.
The swelling is the result of the blockage of blood, tissue fluids and circulation in the heel because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating, blood and fluids back up behind the injured heel, causing pain, inflammation, lumps and swelling.
Below is a list of common signs and symptoms of retrocalcaneal bursitis. Recognizing and treating symptoms early can prevent retrocalcaneal bursitis from becoming chronic. Swelling. The retrocalcaneal bursa is located behind the Achilles tendon, just above where the tendon attaches to the heel bone. When the bursa is inflamed it will cause visible soft tissue swelling near the top of the heel bone. It is worth noting that bursitis of the retroachilles bursa, which is located between the Achilles tendon and skin, can manifest slightly differently: swelling may be more distinct, appearing as a hard lump behind the heel. Retroachilles bursitis is also more likely than retrocalcaneal bursitis to cause the skin at the back of the heel to turn red.
On physical examination, patients have tenderness at the site of the inflamed bursa. If the bursa is superficial, physical examination findings are significant for localized tenderness, warmth, edema, and erythema of the skin. Reduced active range of motion with preserved passive range of motion is suggestive of bursitis, but the differential diagnosis includes tendinitis and muscle injury. A decrease in both active and passive range of motion is more suggestive of other musculoskeletal disorders. In patients with chronic bursitis, the affected limb may show disuse atrophy and weakness. Tendons may also be weakened and tender.
Non Surgical Treatment
Treatment consists of anti-inflammatory therapy with the use of ice, short term non steroidal therapy including ibuprofen and naproxen and selective use of cortisone injections. Cortisone injections have been shown to be a highly effective anti-inflammatory measure for relieving foot and ankle pain. Care must always be taken by the physician to insure that the injection is administered into the bursal sac and not the Achilles tendon which can cause tendon injury. Treatment also consists of the use of heel lifts or the temporary use of a shoe with a low heel. The heel lift decreases the mechanical load on the Achilles tendon. Gentle stretching of the Achilles tendon, the possible use of a splint that is worn at night as well as physical therapy as directed by your physician can be employed. Temporary activity limitations for fitness must be incorporated into the treatment plan. Any weight bearing activity for exercise that actively lifts your heel off of the ground including running, walking stair stepper will interfere with effective conservative care. Low impact activity including biking and pool tend to be safe exercises during your recovery.
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).
After taking a history and performing a physical examination, your physician may order x-rays to rule out other disorders. Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain. Also, to reduce swelling, your physician may draw excess fluid from the bursa with a syringe and then tightly wrap and compress the joint with an elastic bandage. In severe, persistent cases surgery to remove the bursa may be necessary. For infectious bursitis, antibiotics will be prescribed.