I recently posted a foot pain discussion of Achilles tendonitis that I feel helps a patient suffering with pain on the back of the heel understand what might be going on. However, there is a diagnosis in the same anatomic area that often gets confused with Achilles tendonitis and I thought I should discuss it today. Retrocalcaneal bursitis refers to a fluid filled sac (bursa) that rests behind (retro) the heel bone (calcaneal). This bursa has the unenviable job of cushioning between the heel bone and the Achilles tendon. When this bursa becomes inflamed we call it bursitis.
As a podiatrist in Nacogdoches Texas, I see all types of patients with this painful condition but there is one type I seem to see more than others. This patient, I think, makes a good example for our discussion and should help us better understand the condition. I am speaking of the newly retired cowboy! Lol. This patient has worn cowboy boots for fifty years, usually with a pretty good heel on them, and has now retired from his work where the boots were required. So, he has begun wearing tennis shoes more and unknowingly began a mechanical condition that will lead to pain.
After years of wearing an elevated heel in a shoe, or boot, the tendon becomes adjusted to the length needed in that particular shoe. Over years it can become much shorter and if not stretched properly over those years it can have significant difficulty adjusting to its new environment in a tennis shoe. As the heel gets lower, the pressure between the tendon and heel bone increases and the bursa becomes irritated. I also see this in athletes who have been making their calf muscles bigger but not stretching them properly.
Treatment, after proper diagnosis, usually consists of ice, NSAIDS, physical therapy or steroid injections for the swelling and at some point will include a stretching program to lengthen the tendon. Heel pads and lifts have also been proven to help the situation. Of course, proper assessment is the key and is why I feel a podiatrist is necessary in all conditions concerning the heel.