There is a thick walled fluid filled bursa between the Achilles tendon and the calcaneal bone. The color Doppler images show hypervascularity of the bursal wall. A minimal amount of fluid in the retrocalcaneal bursa can often be found. A retrocalcaneal bursitis is caused by friction of the Achilles tendon over the upper part of the calcaneal bone. It is often an overuse injury found in athletes.
Bursitis, tendinitis, and other soft tissue rheumatic syndromes typically result from one or more factors. These include: Play or work activities that cause overuse or injury to the joint areas Incorrect posture Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint) Other diseases or conditions (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction) Infection.
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.
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis but may be requested to check for any underlying health conditions that may have triggered the bursitis.
Non Surgical Treatment
Conservative treatment includes the use of shoe supports (either a heel raise or a donut-shaped heel cushion) and a limited number of local corticosteroid injections (usually up to three per year). Changing the type of footwear may be essential.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.