Bursitis of the heel

At the level of the attachment of the Achilles tendon to the heel bone there are two bursae. A deeper one, located between the heel bone and the Achilles tendon, and a more superficial one between the Achilles tendon and the skin. Bursitis of the heel is an inflammation of one of those two bursae.

A bursa is a small sac filled with synovial fluid that allows different structures such as tendons, bone, and skin to move easily over each other.

The superficial bursa of the heel, called the bursa subcutanea calcanea, is located between the Achilles tendon and the skin. The deeper bursa of the heel, called the bursa retrocalcanea, lies between the Achilles tendon and the heel bone.

How does bursitis of the heel arise?

Bursitis of the heel will in most cases develop gradually. For the superficial bursa, inflammation is often the result of local damage or trauma to the bursa. A good example of this is rubbing of the shoe edge against the heel; with repeated friction the bursa can become irritated. Inflammation of the deeper bursa is often seen after or during Achilles tendinitis. Swelling of the Achilles tendon crowds the bursa.

Symptoms are seen most often in people aged 40-60 and frequently in people who run or do sports that involve a lot of jumping.

Symptoms of bursitis of the heel

With bursitis of the heel, there are signs such as swelling, warmth, redness, (pressure) pain and limited range of motion.

In the case of a superficial bursitis, a red bump may be visible where the Achilles tendon attaches to the heel bone. This bump can be painful to the touch. Wearing closed shoes can also be painful.

With the deep bursa, in the case of inflammation, the pain can vary. For example, pain can be felt to the left and right of the Achilles tendon and mainly appears after a day of hard work or sports.

How is the diagnosis of bursitis of the heel made?

Bursitis of the heel can generally be diagnosed well by a family doctor or physical therapist. Additional tests, such as ultrasound, CT scan, or MRI scan, will only be necessary in a few cases to establish the diagnosis.

How is bursitis of the heel treated?

It is important to start treatment in time, preferably under the guidance of the physical therapist. First, treatment will focus on pain reduction. Dosed rest and cooling the painful area are very important.

The next step in the treatment pathway focuses on increasing load tolerance. Possible treatment interventions applied by the physical therapist include massage, stretches, exercise therapy, and joint mobilizations.

The prognosis (expected recovery) for bursitis of the heel is generally very good. People are often able to resume their normal activities within a few weeks.