Retrocalcaneal bursitis is closely related to Haglund?s Deformity (or ?pump bumps?). If you have a bony enlargement on the back of the heel that rubs the Achilles tendon, it can cause the formation
of a bursa (small fluid filled sack). It usually happens in athletes as shoes rub against the heel. The bursa can aggravated by the stitching of a heel counter in the shoe as well. It can make
wearing shoes and exercising difficult. Another term used for this condition is ?pump bump? because it can frequently occur with wearing high heels as well. ?Retro-" means behind and ?calcaneus?
means heel bone. So this is precisely where the bursitis (inflammation of the bursa) develops. Once it begins and you develop bursitis between the heel bone and the Achilles tendon, it can become
even more painful. When most people first notice retrocalcaneal bursitis, it is because the skin, bursa and other soft tissues at the back of the heel gets irritated as the knot of bone rubs against
the heel counter in shoes. The back of the shoes create friction and pressure that aggravate the bony enlargement and pinches the bursa while you walk.
Bursitis is commonly caused by overuse and repeated movements. These can include daily activities such as using tools, gardening, cooking, cleaning, and typing at a keyboard. Long periods of pressure
on an area. For example, carpet layers, roofers, or gardeners who work on their knees all day can develop bursitis over the kneecap. Aging, which can cause the bursa to break down over time. Sudden
injury, such as a blow to the elbow. Bursitis can also be caused by other problems, such as arthritis or infection (septic bursitis).
The signs and symptoms of heel bursitis can include heel pain wearing particular footwear, Pain or discomfort in the heel when walking, jogging or running, Swelling or inflammation in the heel.
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
Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce the swelling in the bursa. An injection may be used for both diagnosis
and for treatment. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and ankle to ensure no other problems exist in this area. They may advise you on
different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation. Sometimes patients are sent to Physical Therapy for treatment
as well. To aid in relief of pressure points, some simple padding techniques can be utilized. Most all patients respond to these conservative measures once the area of irritation is 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).