Infracalcaneal bursitis can significantly affect your quality of life and your ability to perform your activities of daily living, due to pain and impaired gait. Inflammation of the bursal sac under
your heel bone occurs because the bursa is abnormally stressed or strained in some way or bears excessive pressure for prolonged periods. Constant pressure and friction from footwear is a common
cause of this health problem, and any treatment plan addressing infracalcaneal bursitis should include recommendations for footwear to avoid or use. Infracalcaneal bursitis may be diagnosed in
several ways, including palpation, or light pressure applied to your affected area. If your heel pain has existed for an extended period, X-ray imaging studies may reveal localized calcification in
your infracalcaneal bursa, though this is not always the case. MRI images are sometimes used as a diagnostic tool for this health problem, though MRI studies are considered unnecessary for diagnosis
in many cases.
Bursitis may be the result of a direct injury to the heel, such as during a car accident, sport-related accident, or fall that causes a forceful impact or abnormal twisting of the foot. It can also
occur due to repetitive use, misuse, or overuse, such as seen in athletic over-training. Excessive pressure over the subcutaneous calcaneal bursa, such from wearing shoes that are tight or fit
poorly, can also be a causative factor. Septic bursitis occurs secondary to an infection. The infection may occasionally be systemic, but is most often a localized infection from a subcutaneous heel
wound that leaks into the underlying bursa. Other risk factors include any of the following, existing Achilles tendinitis, existing Haglund's deformity, the natural degenerative processes of aging,
improper stretching prior to exercise, anatomical differences in the lower extremities that impacts gait, having deformed joints.
Pain at the back of the heel at the attachment site of the Achilles tendon when running. Pain on palpation of the back of the heel or bottom of heel. Pain when standing on tiptoes. Swelling and
redness at the back and bottom of the heel.
The diagnosis is based on the symptoms and an examination. For anterior Achilles tendon bursitis, doctors use x-rays to rule out a fracture of the heel bone or damage to the heel bone caused by
rheumatoid arthritis or other inflammatory arthritis.
Non Surgical Treatment
All types of bursitis often can be successfully managed non-surgically, and possible treatments include use of ice packs or compressive dressings, activity modification that may reduce stress or
irritation, administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics, corticosteroid injections (knee and elbow), stretching exercises, and/or change of footwear (heel). Surgery
may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.