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Retrocalcaneal bursitis is swelling (inflammation) of the fluid-filled sac (bursa) at the back of the heel bone (calcaneus).

A bursa acts as a cushion and lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle.

The retrocalcaneal bursa is located in the back of the ankle by the heel. It is where the large Achilles tendon connects the calf muscles to the heel bone.

Repeated or too much use of the ankle can cause this bursa to become irritated and inflamed. Possible causes are excessive walking, running, or jumping.

This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for Achilles tendonitis.

Those at risk for this condition include people just starting aggressive exercise regimens or who suddenly increase their activity without proper conditioning.

• Pain in the heel, especially with walking, running, or when the area is touched
• Pain may get worse when rising on the toes (standing on tiptoes)
• Red, warm skin over the back of the heel

Your health care provider will take a history to find out if you have symptoms of retrocalcaneal bursitis. Examining your ankle can find the location of the pain. The physician will look for tenderness and redness in the back of the heel.

The pain may be worse when the doctor bends the ankle upward (dorsiflex). Or, the pain may be worse when you rise on your toes.

Imaging studies such as x-ray and MRI are not usually necessary at first. If the first treatment fails to improve the symptoms, your health care provider may recommend these studies. MRI may show inflammation.

Your health care provider may recommend the following treatments:

• Avoid activities that cause pain.
• Ice the heel several times a day.
• Take nonsteroidal anti-inflammatory medications (for example, ibuprofen).
• Try over-the-counter or custom heel wedges to help decrease the stress on the heel.
• Use physical therapy to improve flexibility and strength around the ankle, which can help the bursitis improve and prevent it from coming back.

If these treatments don't work, your health care provider may inject a small amount of steroids into the bursa. If the condition is associated with Achilles tendonitis, casting the ankle for several weeks to keep it in from moving can be effective. Very rarely, surgery may be necessary to remove the inflamed bursa.

This condition usually gets better in several weeks with the proper treatment.

Complications are uncommon. If the bursitis is associated with tendonitis, tendon rupture is a possible complication. Tendon rupture may also occur with steroid injections, especially if they are given too often.

If you have heel pain or symptoms of retrocalcaneal bursitis that do not improve with rest, contact your health care provider for evaluation and treatment.

Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition.

Proper stretching of the Achilles tendon helps prevent injury.

Insertional heel pain

Aranow MS. Posterior heel pain (retrocalcaneal bursitis, insertional and noninsertional Achilles tendinopathy). Clin Podiatr Med Surg. 2005;22:19-43.

Updated by: Andrew L. Chen, MD, MS, Orthopedist, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.