A lesser known type of heel pain is a condition called Bursitis of the Heel. A bursa is a fluid-filled sac that cushions the muscles, tendons and bones in our joints. It helps keep them from rubbing against each other and reduces friction in the areas around the joints. Bursitis is Latin for inflammation of the bursa. Repeated movement and pressure on the bursa can cause it to swell and become inflamed. Trauma, infection or crystal deposits can also cause Bursitis. The joints that are usually affected by bursitis are the large joints such as the shoulder, hip and knee but in some cases also the back of the heel.
Bursitis can be caused by an injury, an infection, or a pre-existing condition in which crystals can form in the bursa. Injury. An injury can irritate the tissue inside the bursa and cause inflammation. Doctors say that bursitis caused by an injury usually takes time to develop. The joints, tendons, or muscles that are near the bursae may have been overused. Most commonly, injury is caused by repetitive movements.
Symptoms include pain at the back of the heel, especially when running uphill or on soft surfaces. There will be tenderness and swelling at the back of the heel which may make it difficult to wear certain shoes. When pressing in with the fingers both sides are the back of the heel a spongy resistance may be felt.
During the physical examination of a patient with calcaneal bursitis, the physician should keep the following considerations in mind. Swelling and redness of the posterior heel (the pump bump) may be clearly apparent. The inflamed area, which may be slightly warm to the touch, is generally tender to palpation. Careful examination can help the clinician to distinguish whether the inflammation is posterior to the Achilles tendon (within the subcutaneous calcaneal bursa) or anterior to the tendon (within the subtendinous calcaneal bursa). Differentiating Achilles tendinitis/tendinosis from bursitis may be impossible. At times, the 2 conditions co-exist. Isolated subtendinous calcaneal bursitis is characterized by tenderness that is best isolated by palpating just anterior to the medial and lateral edges of the distal Achilles tendon. Conversely, insertional Achilles tendinitis is notable for tenderness that is located slightly more distally, where the Achilles tendon inserts on the posterior calcaneus. A patient with plantar fasciitis has tenderness along the posterior aspect of the sole, but he/she should not have tenderness with palpation of the posterior heel or ankle. A patient with a complete avulsion or rupture of the Achilles tendon demonstrates a palpable defect in the tendon, weakness in plantarflexion, and a positive Thompson test on physical examination. During the Thompson test, the examiner squeezes the calf. The test is negative if this maneuver results in passive plantarflexion of the ankle, which would indicate that the Achilles tendon is at least partially intact.
Non Surgical Treatment
Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence in all patients with retrocalcaneal bursitis. Treatment may comprise soft tissue massage (particularly to the calf muscles), joint mobilization (of the ankle, subtalar joint and foot), dry needling, electrotherapy (e.g. ultrasound), stretches, the use of heel wedges, the use of crutches, ice or heat treatment, arch support taping, the use of a compression bandage, exercises to improve strength, flexibility, balance and core stability, education, anti-inflammatory advice, activity modification advice, biomechanical correction (e.g. the use of orthotics), footwear advice, a gradual return to activity program.
Contact your physician if bursitis pain is disabling (when movement of the joint is largely or entirely restricted), if the pain doesn?t subside after a week of self-care, or if the joint is red and swollen. Also call your doctor if you develop a fever, which could signal infectious bursitis-a condition that especially can afflict the elbow. Except for the fever, symptoms resemble other forms of bursitis, but infectious bursitis requires immediate medical attention.