Bursitis is an inflammation of a bursa. The heel has three areas that are involved in bursitis. Retrocalcaneal Bursa which is located between the Achilles tendon and heel bone. Subcutaneous calcaneal
bursa which is located between the skin and where the Achilles tendon attaches to the heel bone. Plantar-calcaneal bursitis is located between the heel bone and the plantar fascia (thick fibrous
tissue that inserts into the heel bone).
Causes of bursitis can be from any form of friction between bone and the soft tissues. The most common cause is due to abnormal pronation.
Unlike Achilles tendinitis, which tends to manifest itself slightly higher on the lower leg, Achilles tendon bursitis usually creates pain and irritation at the back of the heel. Possible signs of
bursitis of the Achilles tendon include difficulty to rise on toes. Standing on your toes or wearing high heels may increase the heel pain. Inflammation and tenderness. The skin around your heel can
become swollen and warm to the touch. Redness may be visible. Pain in the heel. Pain tends to become more prominent when walking, running, or touching the inflamed area. Stiffness. The back of your
ankle may feel a little stiff due to the swelling of the bursa.
Your doctor will check for bursitis by asking questions about your past health and recent activities and by examining the area. If your symptoms are severe or get worse even after treatment, you may
need other tests. Your doctor may drain fluid from the bursa through a needle (aspiration) and test it for infection. Or you may need X-rays, an MRI, or an ultrasound.
Non Surgical Treatment
With anterior and posterior Achilles tendon bursitis, applying warm or cool compresses to the area and using nonsteroidal anti-inflammatory drugs (NSAIDs) can temporarily relieve the pain and
inflammation, as can injections of a corticosteroid/anesthetic mixture into the inflamed bursa. The doctor is careful not to inject the mixture into the tendon. After this treatment, the person
should rest. When these treatments are not effective, part of the heel bone may need to be surgically removed.
Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a
pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle
or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be
underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).