There are lots of bursa located around the body. They are found at joints and they act as a buffer between tendons and joints to allow for a proper range of movement and function. However, if you irritate a bursa or over use it, they can fill up and become inflamed which then makes it painful and they are classified then as bursitis.
Common locations for bursitis include the retrocalcaneal bursitis at the Achilles, the patella tendon at the knee and a greater trochanteric bursitis at the hip.
Anatomy
The retro calcaneal bursa is located between the Achilles tendon and the heel bone. It allows for normal movement of the ankle in dorsiflexion and plantarflexion. When it becomes inflamed, it will cause pain quite specific to the area it is located in the back of the ankle and direct palpation will generally cause pain. It can feel swollen and even look swollen and puffy at the area.
Signs and Symptoms
Pain when walking, especially uphill walking in the area of the bursa at the back of the ankle and the Achilles area. It can be a throbbing, stabbing or burning pain and will generally get worse the more you are on it or the more walking you do and it will normally ease with rest.
What causes Retro Calcaneal Bursitis
Irritation and friction of the bursa due to an increase in uphill walking or running or an increase in jumping activities. Tight calf or soleus muscles, incorrect footwear, poor foot mechanics in the form of high or low arch feet.
Diagnosis
The location of the pain and description of the pain along with direct palpation will often be sufficient to diagnose this problem. Imaging via ultrasound or MRI can also be used to confirm the size of the bursa and help rule out a possible differential diagnosis of an inflamed fat pad for example or a posterior ankle impingement such as an Os Trigonum.
Differential diagnosis
Os Trigonum
Posterior ankle impingement
Achilles tendonitis
Plantaris friction syndrome
Sural nerve irritation
Ankle or Sub Talar Joint Osteo arthritis
Retro Calcaneal Bursitis Treatment
Ice, NSAIDS such as ibuprofen, Stretches, strengthening, immobilisation aircast boot, footwear changes, orthotics, laser therapy, shockwave therapy and steroid injections are all possible treatments for the condition.