Retrocalcaneal Bursitis

Retrocalcaneal bursitis is the most common heel bursitis.

Retrocalcaneal bursitis is inflammation of the bursa (a small sac located where tendons pass over areas of bone around the joints), which lies over your heel (calcaneum) where your Achilles tendon inserts.

OR

Retrocalcaneal bursitis is inflammation of the bursa located between the calcaneus and the anterior surface of the Achilles tendon.

Anterior or deep to the tendon is the retrocalcaneal bursa, which is located between the Achilles tendon and the calcaneus.

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EPIDEMIOLOGY AND CAUSES

In normal population its incidence is high in individuals who have habit of wearing high heeled footwear on a long-term basis may experience increased stretch and irritation of the Achilles tendon and its associated bursae when switching to flat shoes. It is fairly common in United States.

Calcaneal bursitis is observed in men and women. With increased risk in women who wear high-heeled shoes.

Calcaneal bursitis is commonly observed in middle-aged and elderly persons.

CAUSES

Overtraining in athletes

Tight or poorly fitting shoes that produce excessive pressure at the posterior heel

Haglund’s deformity

Altered joint axis

Overuse from walking, running, or jumping can all cause retrocalcaneal bursitis. It’s common in athletes, especially runners and ballet dancers

CLINICAL FEATURES AND PATHOPHYSIOLOGY

The main symptom of retrocalcaneal bursitis is heel pain.

Swelling around back of your heels

Pain when leaning back on your heels

Pain in calf muscles when running or walking

Stiffness

Red and warm skin on back of heel

Loss of movement

Crackling sound when flexing foot

Shoes becoming uncomfortable

PATHOPHYSIOLOGY

It often results from overuse injury. Retrocalcaneal bursitis may also be associated with conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies. In some cases, retrocalcaneal bursitis may be caused by bursal impingement between the Achilles tendon and an excessively prominent posterosuperior aspect of the calcaneus called Haglund deformity. In Haglund disease, impingement occurs during ankle dorsiflexion.

Lohrer and Nauck indicated that retrocalcaneal bursa pressure rises in patients with chronic retrocalcaneal bursitis, which in turn suggested the investigators that it can cause an impingement lesion on the anterior Achilles tendon

PHYSICAL EXAMINATION AND DIAGNOSIS

Physical examination reveals pain and swelling around the insertion of achilles tendon is a hallmak sign.

Refer link below for further reference

https://youtu.be/RYqg_tpgTlM

A thorough physical examination includes evaluation of the tendon, bursa and calcaneum by, careful history, inspection of the region for bony prominence and local swelling as well as palpation of the area of maximal tenderness.

Biomechanical abnormalities, joint stiffness and proximal soft tissue tightening can exacerbate an anatomical predisposition to retrocalcaneal bursitis, they warrant correction when present.

Plain radiographs of the calcaneus may reveal a Haglund deformity.

Individuals with retrocalcaneal bursitis may have an absence of the normal radiolucency that is seen in the posteroinferior corner of the Kager fat pad, known as the retrocalcaneal recess or bursal wedge. This may occur with or without an associated erosion of the calcaneus.

Magnetic resonance imaging (MRI) may demonstrate bursal inflammation.

Ultrasonography may be a useful tool for diagnosing pathologies of the Achilles tendon.

PHYSIOTHERAPY MANAGEMENT

The patient with retrocalcaneal bursitis is advised to apply ice to the posterior heel and ankle in the acute period of the bursitis. Icing can be performed several times a day, for 15-20 minutes each. Contrast Bath is also recommended. Ultrasound and other pain reducing electrotherapy modalities
are also recommended by clinicians.

Gradual progressive stretching of the Achilles tendon may help relieve impingement on the subtendinous bursa and can be performed in the following manner:

Stand in front of a wall, with the affected foot flat on the floor.

Lean forward toward the wall until a gentle stretching is felt within the ipsilateral Achilles tendon.

Maintain the stretch for 20-60 seconds and then relax.

Perform the stretches with the knee extended and then again with the knee flexed.

Repeat the above steps for several stretches per set, several times daily. Avoid ballistic and jerky stretches.

Other rehabilitation exercises are given in the below link

https://youtu.be/QMzke6N9Xtk

https://youtu.be/QMfuYixVgJk

Taping For Retrocalcaneal Bursitis is given in the below link

https://youtu.be/xudX9eopeA4

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