Retrocalcaneal bursitis is closely related to Haglund?s Deformity (or ?pump bumps?). If you have a bony enlargement on the back of the heel that rubs the Achilles tendon, it can cause the formation of a bursa (small fluid filled sack). It usually happens in athletes as shoes rub against the heel. The bursa can aggravated by the stitching of a heel counter in the shoe as well. It can make wearing shoes and exercising difficult. Another term used for this condition is ?pump bump? because it can frequently occur with wearing high heels as well. ?Retro-” means behind and ?calcaneus? means heel bone. So this is precisely where the bursitis (inflammation of the bursa) develops. Once it begins and you develop bursitis between the heel bone and the Achilles tendon, it can become even more painful. When most people first notice retrocalcaneal bursitis, it is because the skin, bursa and other soft tissues at the back of the heel gets irritated as the knot of bone rubs against the heel counter in shoes. The back of the shoes create friction and pressure that aggravate the bony enlargement and pinches the bursa while you walk.
Inflammation of the bursa causes synovial cells to multiply and thereby increases collagen formation and fluid production. A more permeable capillary membrane allows entrance of high protein fluid. The bursal lining may be replaced by granulation tissue followed by fibrous tissue. The bursa becomes filled with fluid, which is often rich in fibrin, and the fluid can become hemorrhagic. One study suggests that this process may be mediated by cytokines, metalloproteases, and cyclooxygenases.
Your heel may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
Diagnosis is first by clinical suspicion of symptoms. This can be mistaken for gout or infection especially in the big toe region. A diagnosis of bursitis is usually used in combination of the underlying cause, for instance a bunion deformity, Haglund’s deformity, or Heel Spur Syndrome. Many times the cause needs to be addressed to rid the problem of bursitis.
Non Surgical Treatment
The following exercises are commonly prescribed to patients with retrocalcaneal bursitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2, 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free.
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.