What Is Retrocalcaneal Bursitis?

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Retrocalcaneal bursitis, or heel bursitis, is a condition that causes swelling of the bursa, a fluid-filled sac, on the heel bone. 

You have bursae throughout your body. These sacs cushion your tendons and muscles as you move, preventing them from rubbing vigorously against your bones. In some cases, often with overuse, these sacs can become inflamed and irritated. Retrocalcaneal bursitis specifically affects the bursa on the heel. 

This article explores heel bursitis symptoms, causes, diagnosis, treatment, and prognosis.

Close-up of runner stopping and feeling ankle pain

Mixmike / Getty Images

Retrocalcaneal Bursitis Symptoms

Heel bursitis may cause the following symptoms:

  • Pain, swelling, and tenderness, specifically at the back of your heel
  • Pain that’s worse when you press directly on the area
  • Redness or warmth on the back of your heel
  • Worsening pain when you stand on your toes 
  • Worsening pain when you flex your ankle upward

What Causes Retrocalcaneal Bursitis?

The most common cause of any bursitis is overuse. In the case of retrocalcaneal bursitis, overuse may include repetitive movements from activities like running, walking, or jumping. It's especially common in professional athletes.

If you increase your activity levels too quickly, you may experience pain and inflammation in the heel area. You can also experience bursitis if you adjust your activity levels or change the type of activities you're doing.

For example, your usual exercise routine might involve intense cycling sessions, and you decide to try running at the same intensity for the same amount of time. Your muscles, joints, and tendons may need more time before they're ready to take on the strain and impact of this new activity. 

People with inflammatory arthritis (such as rheumatoid arthritis) may be at higher risk of developing bursitis.

Other Causes of Heel Pain

Heel bursitis isn’t the only potential cause of heel pain. Other reasons your heel is hurting may include the following:

  • Bruising
  • Plantar fasciitis: Another overuse injury that causes pain under the heel 
  • Achilles tendonitis: An inflammation of the heel bone tendon
  • Haglund's deformity: A bony bump that forms where your Achilles tendon attaches at the back of the calcaneus (heel bone), resulting in the Achilles rubbing and degrading the bone
  • Calcific insertional Achilles tendinopathy: A type of heel spur where the Achilles tendon itself becomes bony, or bony fragments form

These can occur independently of each other or exist together.

Diagnosis

Because Achilles tendonitis and retrocalcaneal bursitis share similar symptoms and affect the same area, it may be difficult to tell the difference between them.

A healthcare provider will diagnose retrocalcaneal bursitis based on your symptoms and where exactly you’re experiencing pain. Redness and inflammation at the back of the heel are also clues that your symptoms result from heel bursitis.

Often an X-ray will be performed to give information about the bones. While this doesn't inform the healthcare provider about the soft tissues (such as tendons, ligaments, etc.), it can help rule out some diagnoses.

Soft tissue imaging by ultrasound or magnetic resonance imaging (MRI) might be done at a follow-up visit.

Treatment for Retrocalcaneal Bursitis

You can likely treat retrocalcaneal bursitis on your own at home by:

  • Icing the area a few times a day (keep a cloth between your skin and the ice pack)
  • Taking over-the-counter (OTC) medications to help with pain, swelling, and inflammation, such as Advil (ibuprofen) or Aleve (naproxen)
  • Padding your shoes to provide extra cushion to the heel until the pain and swelling go away
  • Avoiding anything that makes the pain worse, which typically means stopping physical activity until the injury heals
  • Using an OTC heel lift
  • Doing light Achilles tendon stretching

In cases in which at-home remedies don’t help, you may find it beneficial to see a physical therapist. In physical therapy, you will learn to do exercises to strengthen the muscles supporting your heel and improve ankle flexibility.

With bursitis that doesn’t go away, a healthcare provider may recommend steroid injections to reduce inflammation. But this procedure has a significant hazard of Achilles tendon rupture. It must be carefully performed, preferably with ultrasound imaging to assure the Achilles tendon is not impacted.

One 2017 study that looked at 20 fresh-frozen Achilles tendon specimens found that there may be a risk of Achilles tendon rupture with corticosteroid injections used to treat retrocalcaneal bursitis.

Very rarely does heel bursitis require surgery.

Prognosis

Most of the time, heel bursitis clears up on its own with rest and icing. However, it can take a few weeks to heal completely and for you to get back to your usual physical activity levels.

When returning to physical activity after heel bursitis, it’s essential to get back into things slowly. Ramping up too fast can cause the injury to return. Talk with a healthcare provider or physical therapist if you’re unsure how to gradually get back to your usual workouts. 

Summary

Retrocalcaneal bursitis or heel bursitis occurs when the fluid-filled sacs at the back of the heel, called bursae, become irritated and inflamed. This happens due to repetitive movement. It’s more likely to occur if you increase your activity levels too quickly or change your physical activity routine.

A Word From Verywell

It can be exciting to start or try a new exercise routine. But to avoid injury, taking things one step at a time is crucial. Your cardiovascular system is likely to improve faster than your muscles, making it tempting to ramp up the intensity before your muscles are quite ready. 

Taking things slow and steady will ensure you can continue participating in your favorite physical activities without being sidelined by injuries. 

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. MedlinePlus. Bursitis of the heel.

  2. Pekala PA, et al. The Achilles tendon and the retrocalcaneal bursa. Bone Joint Res. 2017;6(7):446-451. doi:10.1302/2046-3758.67.BJR-2016-0340.R1

  3. OrthoInfo. Heel pain.

  4. University of Michigan Health. Using ice and cold packs.

  5. NHS. Bursitis.

By Steph Coelho
Steph Coelho is a freelance health writer, web producer, and editor based in Montreal. She specializes in covering general wellness and chronic illness.