Retroductal bursitis causes symptoms relationship to weight and treatment

If you feel annoying pain behind your heel, especially while walking or wearing shoes, you should not ignore it. This discomfort may be related to a condition called retrocalcaneal bursitis. This problem happens when the small fluid-filled sac that helps the Achilles tendon move smoothly above the heel bone becomes inflamed, making every step painful and uncomfortable.What makes this condition important is that it does not only affect your daily comfort, but it can also worsen over time and affect the way you walk and move if left untreated. The causes of retrocalcaneal bursitis are varied and may include tight shoes, excessive physical activity, excess body weight, or even certain foot problems.In this article by Dalili Medical, we will discuss the causes of retrocalcaneal bursitis, its symptoms, possible complications, its relationship with body weight, and the best treatment and prevention methods to help you manage the condition early before it becomes more serious.

What Is Retrocalcaneal Bursitis?

Retrocalcaneal bursitis is an inflammation of a small fluid-filled sac located behind the heel bone, specifically between the heel bone and the Achilles tendon. When this bursa becomes inflamed, it can cause pain and swelling at the back of the heel, especially during walking or movement. The condition often develops بسبب repetitive stress, running, or wearing tight and uncomfortable shoes that rub against the heel.

Can High Heels Cause Retrocalcaneal Bursitis?

Yes, wearing high heels may increase the risk of developing this condition because they:

Increase pressure on the back of the heel
Cause abnormal friction in the area
May irritate the bursa over time

Can the Condition Affect One Foot or Both Feet?

In most cases, retrocalcaneal bursitis affects only one foot. However, it can occur in both feet if the cause is general, such as:

Wearing unsuitable footwear
Repetitive excessive physical activity

Does Retrocalcaneal Bursitis Affect Normal Walking?

Yes, it can noticeably affect walking and may cause:

A slight limp during movement
Changes in walking style to avoid pain
Extra strain on other parts of the foot or even the knees due to compensation while walking

Can Retrocalcaneal Bursitis Become Chronic?

Yes, the condition may become chronic in the following situations:

Ignoring treatment and delaying medical care
Continuing the underlying cause, such as wearing tight or improper shoes

Are There Foods or Vitamins That Help With Treatment?

There are no specific foods that directly cure bursitis, but:

A healthy diet may help reduce inflammation in general
Foods rich in omega-3 fatty acids, fresh vegetables, and fruits may support joint and tissue health

Is Retrocalcaneal Bursitis Dangerous?

In most cases, it is not considered a serious condition, but it can be painful and affect quality of life. The condition may become more concerning if:

Treatment is ignored for a long time
A bacterial infection develops
Walking and movement become significantly affected

What Is the Difference Between Retrocalcaneal Bursitis and Achilles Tendinitis?

Retrocalcaneal Bursitis

Pain occurs in the fluid-filled sac located between the heel bone and the Achilles tendon. It is usually caused by repeated friction or pressure.

Achilles Tendinitis

Pain occurs in the Achilles tendon itself due to overuse or inflammation.

Although the two conditions occur in nearby areas, the causes and affected tissues are different.

Can Retrocalcaneal Bursitis Go Away Without Treatment?

In mild cases, the inflammation may improve with:

Rest
Changing footwear
Avoiding pressure on the heel

However, many cases require proper treatment to prevent the condition from becoming chronic or recurring.

Does Walking Increase the Pain?

Yes, walking can worsen the pain, especially when wearing uncomfortable shoes or when direct pressure is placed on the heel area, leading to increased inflammation.

Does Treatment Require Surgery?

No, surgery is not necessary in most cases. It is usually considered only in:

Chronic cases
The presence of bone deformities
Failure of conservative treatments

Can the Condition Return After Treatment?

Yes, retrocalcaneal bursitis may recur if the underlying cause continues, such as:

Wearing tight or unsuitable shoes
Excessive physical activity without enough rest

Is There a Relationship Between Retrocalcaneal Bursitis and Weight?

Yes, excess body weight increases pressure on the heel area, making the bursa more vulnerable to inflammation and recurrent injury.

Types of Retrocalcaneal Bursitis

Retrocalcaneal bursitis can vary depending on the cause and severity of inflammation, which helps doctors determine the most suitable treatment for each case.

1. Acute Retrocalcaneal Bursitis (Acute Bursitis)

Appears suddenly over a short period, often within a few days
Commonly caused by excessive physical activity or direct pressure on the heel
Characterized by severe pain and obvious swelling at the back of the heel
The pain usually worsens quickly while walking or wearing shoes

2. Chronic Bursitis

Chronic bursitis develops gradually and lasts for a long period of time. It is commonly caused by repeated friction or improper use of the foot.

The pain is usually less severe than in acute bursitis, but it is persistent.
It may lead to thickening or enlargement of the affected area over time.

3. Non-Infectious (Mechanical) Bursitis

This is the most common type of retrocalcaneal bursitis.

It usually results from repeated pressure or friction, such as:

Wearing tight shoes
Intense running or physical activity

This type is not caused by a bacterial infection.

4. Septic Bursitis

Septic bursitis is a rare but relatively more serious condition caused by a bacterial infection.

Its main symptoms include:

Severe redness around the area
Noticeable local warmth
Intense pain even at rest
Sometimes accompanied by fever

5. Secondary Bursitis

This type develops as a result of other medical conditions, such as:

Inflammatory diseases like rheumatoid arthritis
Gout
Foot problems such as Achilles tendinitis, which increases pressure on the bursa and may lead to inflammation

Causes of Retrocalcaneal Bursitis

Retrocalcaneal bursitis is an inflammatory condition affecting a small fluid-filled sac located between the Achilles tendon and the heel bone. The main role of this bursa is to reduce friction during movement.

When inflammation occurs, the area becomes noticeably painful, especially during walking or when wearing tight shoes.

1. Repeated Pressure and Friction

Wearing tight or hard-backed shoes
Continuous friction between the shoe and the heel
Using uncomfortable footwear for long periods

2. Overuse of the Foot

Excessive running or jumping
Standing for long periods, especially on hard surfaces
Sudden increase in physical activity without gradual progression

3. Achilles Tendon Inflammation or Strain

Inflammation or strain of the Achilles tendon may increase pressure on the bursa beneath it, leading to bursitis.

4. Direct Injuries

A direct blow to the heel area
Sudden twisting injuries of the foot or ankle

5. Foot Deformities

A bony prominence at the back of the heel
Increased bone curvature known as Haglund deformity

These deformities increase friction and pressure on the bursa.

6. Inflammatory Diseases

Conditions such as:

Rheumatoid arthritis
Gout

can make the tissues more prone to inflammation and irritation.

Symptoms and Diagnosis of Retrocalcaneal Bursitis

First: Symptoms

Symptoms of retrocalcaneal bursitis are usually noticeable and often develop gradually. They may include:

1. Pain Behind the Heel

Pain appears between the Achilles tendon and the heel bone
It worsens with walking, running, or standing for long periods
The pain may become more severe when wearing tight or hard-backed shoes

2. Swelling Behind the Heel

Swelling of varying degrees appears at the back of the heel
In some cases, the area may look prominent or red

3. Tenderness to Touch

Direct pressure on the area may cause significant pain and sensitivity.

4. Stiffness and Difficulty Moving

Often noticeable after waking up or after periods of rest
The patient may feel difficulty moving the foot normally

5. Increased Pain While Wearing Shoes

Symptoms often worsen with closed or tight shoes that press against the heel.

6. Redness or Local Warmth

In some cases, redness and warmth of the skin over the affected area may appear.

Diagnosis of Retrocalcaneal Bursitis

Diagnosis is usually made by an orthopedic doctor or sports medicine specialist and involves several steps:

1. Medical History

The doctor may ask about:

When the pain started: suddenly or gradually
Physical activities such as running, prolonged walking, or standing
The type of shoes commonly worn
Previous injuries or trauma to the heel
Whether the pain increases with movement or shoe wear

2. Physical Examination

The doctor examines the foot and heel to:

Check for swelling behind the heel
Detect redness or local warmth
Identify the exact location of pain
Differentiate the condition from Achilles tendinitis

3. Movement Tests

These may include:

Moving the foot up and down
Standing on tiptoes
Observing whether pain increases with movement or pressure

4. Medical Imaging Tests (If Needed)

These tests are not required in every case but may help confirm the diagnosis.

X-ray

Used to detect:

Bone spurs
Heel bone deformities such as Haglund deformity

Ultrasound

Helps identify fluid accumulation or inflammation inside the bursa.

MRI

Used in complicated cases or when injury to surrounding tissues or the Achilles tendon is suspected.

Complications of Retrocalcaneal Bursitis

In most cases, serious complications do not occur if retrocalcaneal bursitis is treated early. However, neglecting the condition or continuing to put pressure on the affected area may lead to several long-term problems.

1. Chronic Inflammation

Pain and swelling may persist for long periods
Symptoms may not improve with simple rest alone
Longer treatment and regular physical therapy may become necessary

2. Increased Pain and Difficulty Walking

Pain may become constant, even during rest
Walking or wearing shoes may become significantly painful
Daily activities and quality of life may be directly affected

3. Fibrosis or Thickening of the Bursa

Repeated inflammation may lead to thickening of the tissues around the bursa.

The area may become firmer and less flexible
The risk of recurrent inflammation increases over time

4. Effects on the Achilles Tendon

The inflammation may spread to nearby tissues, especially the Achilles tendon, which may lead to:

Increased inflammation of the Achilles tendon Achilles tendinitis
Gradual weakening of tendon function
More severe pain and difficulty moving in advanced cases

5. Abnormal Walking and Reduced Mobility

The patient may change the way they walk to avoid pain
This change can place extra stress on other joints such as the knees or other parts of the foot
It may also lead to muscular imbalance and strain

6. Rare Complications in Cases of Infection

In the uncommon cases where bursitis is caused by a bacterial infection:

The infection may spread if not treated quickly
Redness, warmth, and pain may become significantly worse
Urgent medical treatment may become necessary

Medications for Treating Retrocalcaneal Bursitis

Drug treatment mainly aims to reduce pain and inflammation and treat the underlying cause if present. The choice of medication depends on the severity and type of bursitis.

First: Pain Relievers and Anti-Inflammatory Medications (Main Treatment)

These are usually the first step in treatment.

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Examples include:

Ibuprofen
Diclofenac
Naproxen

Their benefits include:

Reducing pain
Decreasing swelling and inflammation
Improving movement and mobility

Important Notes

These medications should be taken after meals to reduce stomach irritation
Long-term use without medical supervision is not recommended
They should be used cautiously in people with stomach or kidney problems

2. Simple Pain Relievers

Example:

Paracetamol (Acetaminophen)

Its role:

Relieves pain only without directly reducing inflammation
Often used in mild cases or as supportive treatment

Second: Topical Treatments (Creams and Gels)

Examples include:

Diclofenac gel
Anti-inflammatory creams

Benefits:

Applied directly to the back of the heel
Help reduce localized pain
Relatively safe for mild to moderate cases

Third: Cortisone Injections (For Moderate to Severe Cases)

Injected directly into or around the bursa
Provide fast relief from inflammation and pain

Important Considerations

Should not be repeated excessively
Must be performed under medical supervision
Overuse may weaken surrounding tissues, especially the Achilles tendon

Fourth: Antibiotics (For Septic Bursitis)

Antibiotics are used only when bursitis is caused by a bacterial infection.

Examples may include:

Amoxicillin-clavulanate
Cephalosporins
Or antibiotics selected according to bacterial culture results

Common signs of infection include:

Severe redness
Noticeable warmth
Pain even during rest
Sometimes fever

Fifth: Medications for Underlying Conditions

In some cases, bursitis develops because of another medical condition.

1. Gout

Treatment may include:

Medications to lower uric acid levels
Anti-inflammatory drugs during flare-ups

2. Rheumatoid Arthritis

Treatment may include:

Immune-modulating medications
Anti-rheumatic drugs

These medications must be used under close medical supervision.

Surgical Treatment for Retrocalcaneal Bursitis

Surgery for retrocalcaneal bursitis is considered uncommon and is usually recommended only after conservative treatments such as medications, rest, shoe modification, and physical therapy have failed.

It is mainly used in chronic cases or when bone deformities or tendon problems are present.

1. Bursectomy

Concept

Complete removal of the inflamed bursa.

Procedure

A small or medium incision is made behind the heel
The inflamed bursa is reached and removed
Surrounding tissues are cleaned carefully
The incision is then surgically closed

When Is It Used?

Chronic persistent cases
Failure of medication treatment
Recurrent bursitis

2. Endoscopic Bursectomy

Concept

Removal of the bursa using tiny instruments and a small camera without a large surgical incision.

Procedure

Very small openings are made (usually 2–3)
A surgical camera is inserted
The bursa is removed using specialized tools
The patient often goes home the same day

Advantages

Less pain after surgery
Smaller scars
Faster recovery
Lower risk of complications

3. Haglund Deformity Resection

Concept

Removal of the bony prominence causing friction behind the heel.

Procedure

A posterior heel incision is made
The prominent bone is shaved or removed
The bone surface is smoothed to reduce friction
The bursa may also be removed during the same surgery

When Is It Used?

Presence of a noticeable bony prominence
Persistent pain caused by shoe friction

4. Achilles Tendon Debridement

In cases where inflammation extends to the Achilles tendon:

Procedure

The area behind the heel is opened
Inflamed or damaged tendon tissue is removed
Healthy tendon tissue is preserved
In some cases, the tendon is reattached to the heel bone

5. Combined Surgery

Used when more than one problem exists at the same time, such as:

Bursitis
Bone prominence
Achilles tendon inflammation or damage

Procedure

Bursa removal
Removal of the bony prominence
Cleaning or repair of the Achilles tendon during the same operation

6. Traditional Open Surgery

Concept

A larger surgical incision is made for full access to the affected area.

Used In

Severe or complicated cases
Significant fibrosis or tissue changes
Failure of minimally invasive surgeries

7. Achilles Tendon Repair and Reattachment

In very advanced cases:

Damaged or worn tendon tissue is cleaned
The Achilles tendon is reattached to the heel bone using anchors or surgical sutures
Used when tendon weakness or partial tearing is present

Recovery After Surgery

Wearing a splint or medical boot for a certain period
Gradually reducing weight-bearing on the foot
Starting physical therapy after the initial healing stage
Normal walking usually returns within 4 to 8 weeks depending on the condition

Exercises for Retrocalcaneal Bursitis

Exercise therapy is considered one of the most important supportive treatments because it helps reduce pressure on the affected area, speeds up recovery, and lowers the chance of recurrence. Exercises should always be performed gradually and without severe pain.

First: Stretching Exercises (The Foundation of Treatment)

1. Calf Stretch Against the Wall

Stand facing a wall with your hands on it
Place one foot in front of the other
Keep the back heel flat on the ground
Slightly bend the front knee forward
You will feel a stretch in the back calf muscle

Repeat for 20–30 seconds × 3 times for each leg.

Benefits:

Helps reduce tension on the Achilles tendon and heel area

2. Towel Stretch

Sit with your leg extended in front of you
Wrap a towel around the ball of the foot
Gently pull the towel toward you
You will feel a stretch in the calf and behind the heel

Second: Calf Strengthening Exercises

3. Heel Raises

Stand on a flat surface
Slowly raise your heels, then lower them gradually
You can hold onto a chair for balance at first

Repeat 10–15 times × 2–3 sets.

Benefits:

Strengthens the muscles supporting the heel
Reduces pressure on the area

4. Step Heel Raises (Progressive Exercise)

Stand on the edge of a stair
Raise the heels upward, then slowly lower them below the step level
The lowering movement should be very slow

Benefits:

Helps strengthen the Achilles tendon
Reduces pressure on the bursa

Third: Ankle Mobility Exercises

5. Ankle Joint Movements

Lift the foot off the ground
Move it in different directions:
- Up and down
- Right and left
- Circular motions

Perform for 1–2 minutes.

Benefits:

Reduces stiffness
Improves blood circulation

Fourth: Pressure-Relief Exercises

6. Tennis Ball Exercise

Place a small ball under the foot
Roll it slowly under the sole

Benefits:

Helps relax muscles
Reduces tension

7. Light Walking

Walk only on flat surfaces
Wear comfortable shoes with soft heel support
Avoid running or jumping

Important Exercise Tips

Exercises should not cause severe pain
Stop immediately if sharp pain occurs
Avoid tight or hard-backed shoes
Start gradually and increase repetitions slowly
It is preferable to perform exercises daily or 4–5 times per week

Prevention Tips for Retrocalcaneal Bursitis

Preventing retrocalcaneal bursitis is essential to avoid repeated pain and inflammation, especially for people who frequently walk, run, or wear unsuitable footwear.

The main goal of prevention is reducing friction and pressure on the heel area.