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Retrocalcaneal BursitisInjuries > Achilles & Heel > Retrocalcaneal BursitisWhat is a retrocalcaneal bursitis?A bursa is a very thin fluid filled sac found in various places throughout the body. Bursae are designed to reduce friction between layers of tissue and are filled with lubricating fluid. They are located in regions of the body where tissue layers may rub against each other or against bony prominences (figure 1). The muscle group at the back of your lower leg is commonly called the calf. The calf comprises of 2 major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon. Between the Achilles tendon and the heel bone lies a bursa known as the retrocalcaneal bursa (figure 1). During contraction of the calf, tension is placed through the Achilles tendon and this rubs against the retrocalcaneal bursa. Excessively tight shoes may also increase friction on the retrocalcaneal bursa. When this friction is excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. This condition is called a retrocalcaneal bursitis. Signs and symptoms of retrocalcaneal bursitisPatients with this condition typically experience pain during activities requiring strong or repetitive calf contractions such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes). Often pain may be worse with rest after these activities (especially that night or the following morning). Other symptoms may include tenderness and swelling around the Achilles region. Diagnosis of retrocalcaneal bursitisA thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis. Diagnosis may be confirmed with an ultrasound investigation, MRI or CT scan. Treatment for retrocalcaneal bursitisMost patients with retrocalcaneal bursitis heal well with an appropriate physiotherapy program. This however can be a lengthy process and may take some months in patients who have had their condition for a long period of time. Early physiotherapy treatment is vital to hasten recovery. The success rate of the physiotherapy program is largely dictated by patient compliance with the program. One of the key components of the program is that they rest sufficiently from ANY activity that increases their pain until they are symptom free. Activities that cause a delayed increase in pain (especially the following morning) should also be avoided. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient is symptom free a gradual return to these activities is indicated provided there is no increase in symptoms. Following the R.I.C.E. Regime, including regular icing and anti-inflammatory medication, may help to significantly reduce inflammation in the initial phase of this condition. A graduated flexibility, strength and return to activity program under direction from a physiotherapist is vital to ensure an optimal outcome. Contributing factors to the development of retrocalcaneal bursitisThere are several factors which can predispose patients to developing a retrocalcaneal bursitis. These need to be assessed and corrected with direction from a physiotherapist to ensure an optimal outcome. Some of the factors which may contribute to the development of a retrocalcaneal bursitis include:
Physiotherapy for retrocalcaneal bursitisPhysiotherapy treatment is vital to hasten the healing process and ensure an optimal outcome in all patients with this condition. Treatment may comprise:
Other intervention for retrocalcaneal bursitisDespite appropriate physiotherapy management, some patients with retrocalcaneal bursitis do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may include corticosteroid and anaesthetic injection into the retrocalcaneal bursa, an ultrasound, MRI or CT scan to confirm diagnosis, or review by a specialist or podiatrist who can advise on any treatment that may be appropriate to improve the condition. Exercises for retrocalcaneal bursitisThe following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Lunge StretchBegin this exercise with your hands against the wall. Place the leg to be stretched in front of you as demonstrated. Keep your heel down. Gently move your knee forward over your toes until you feel a stretch in the back of your calf or Achilles tendon (figure 2). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.
Figure 2 – Lunge Stretch (right leg) Calf StretchBegin this exercise with your hands against the wall. Place the leg to be stretched behind you as demonstrated. Keep your heel down, knee straight and feet pointing forwards. Gently lunge forwards until you feel a stretch in the back of your calf, knee or Achilles tendon (figure 3). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.
Figure 3 – Calf Stretch (left leg) Find a Physio for retrocalcaneal bursitisFind a physiotherapist in your local area who can treat this condition. Other ExercisesView more calf flexibility exercises. View calf strengthening exercises. View balance exercises. Physiotherapy products for retrocalcaneal bursitisSome of the most commonly recommended products by physiotherapy for patients with this condition include:
To purchase physiotherapy products for retrocalcaneal bursitis click on one of the above links or visit the PhysioAdvisor Shop. Return to the top of Retrocalcaneal Bursitis.
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Figure 1 - Anatomy of Retrocalcaneal Bursitis
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