Retrocalcaneal Bursitis with Tendinosis (Heel Pain)

Diagnosis

The retrocalcaneal bursa is a fluid filled sac that is located in the back portion of the heel bone. It decreases friction between the attachment of the Achilles tendon and the calcaneus at the Achilles tendon insertion. “Bursitis” represents inflammation to this fluid filled sac which causes pain. “Tendinosis” represents thickening of the Achilles tendon at it insertion site on the heel bone related to chronic inflammation.

Symptoms

Pain noted to the back portion of the heel bone at the attachment site of the Achilles tendon.
Swelling and warmth are often noted
Pain with extension of the foot at the ankle level
Pain generally worse with initial rising from a prolonged sitting or laying period

Radiography

X-rays of the heel bone will often show evidence of bone spurring at the back portion of the heel projecting in the line of pull of the Achilles tendon
MRI is generally not indicated

Conservative Treatment

ICE to heel twice daily 10-15 minutes
Anti-inflammatory medications like ibuprofen or naproxen as indicated by treating physician
Calf stretching (Pro-Stretch PS-100)
Shoe with heel or internal heel lift within the shoe
Cast boot or CAM walker with heel lift for three weeks for acute pain
Night splint during all phases of treatment to maintain the foot at ninety degrees to the leg

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