Achilles tendon bursitis (retrocalcaneal bursitis) is a painful condition that commonly occurs in athletes and affects the Achilles tendon and retrocalcaneal bursa.
The Achilles tendon is a large tendon at the posterior of the lower leg which connects the calf muscles to the heel bone (calcaneous) and is used when walking, running, and jumping. The bursa is located at the back of the heel under the Achilles tendon and contains a lubricating fluid that acts as a cushion to reduce friction between the lower leg’s muscles and bones.
Achilles tendon bursitis is caused by overuse of the ankle which results in irritation and inflammation of the bursa. The most common causes include excessive walking, jumping, or running but Achilles tendon bursitis can also occur in conjunction with Achilles tendinitis (inflammation of the Achilles tendon). Children who suddenly increase their level of physical activity are also at high risk for developing Achilles tendon bursitis.
The most common symptom of Achilles tendon bursitis is pain and tenderness at the back of the heel especially when walking or running. This pain may increase when standing on tiptoes and in some cases, the skin at the back of the heel may become warm and red.
The condition is typically diagnosed based on the symptoms and physical examination of the ankle. Diagnostic tests such as x-rays and MRI may also be required for further diagnostics if common treatments fail to improve the symptoms.
The non-surgical treatments listed below are the most common initial options for Achilles tendon bursitis.
- Restrict the activities that cause pain
- Application of ice to the injured area to reduce the swelling
- Non-steroidal anti-inflammatory medications to reduce inflammation and pain
- Custom heel wedges to reduce stress on the heel
- Physical therapy to restore and improve the flexibility and strength of the muscles, tendons, and joints around the ankle
- Corticosteroid injections in the bursa to reduce swelling and pain but with care taken to avoid overstretching the tendon after the injection which may lead to Achilles tendon rupture
- It may be necessary to immobilize the ankle in cases where retrocalcaneal bursitis is associated with Achilles tendonitis. This may be done by applying a cast to the ankle to limit movement and allow the Achilles tendon to rest while healing.
Surgery is typically only considered when all non-surgical treatment fail to resolve the pain and inflammation of Achilles tendon bursitis. In such cases, a bursectomy procedure may be performed to remove a bursa that is inflamed or infected.
Achilles tendon bursitis may be prevented by warming up before and maintaining proper form during exercises.