Retrocalcaneal bursitis or achilles bursitis:

A bursa is a fluid-filled sac-like structure that sits between a tendon and a bone, providing a cushioning effect for ease of movement. The retrocalcaneal bursa is situated in the feet just behind the heel bone, between the Achilles tendon and calcaneus (heel bone), and serves as a cushion to absorb impact when walking. Inflammation of this bursa is called retrocalcaneal bursitis.

What is Retrocalcaneal bursitis?

Inflammation or swelling of the retrocalcaneal bursa due to repetitive strain is known as retrocalcaneal bursitis.

What are the causes:

• This condition is usually due to repeated trauma or stress like- too much walking, running, or jumping.
• Especially when you suddenly increase the intensity of your workout schedule or by increasing the activity level without the right conditioning.
• A sudden impact or other trauma to the heel.
• Food deformities such as altered joint axis, flat feet, etc.
• Due to other conditions like osteoarthritis.

What are the clinical complaints in retrocalcaneal bursitis?

• Pain is the commonest symptom, it is centered on the heel and is intensified with walking, and running.
• Also, there is local tenderness present.
• pain increases when you stand on your toes.
• Sometimes a swelling and red warm skin over the area could appear.

Diagnosis:

• The doctor will take a brief history.
• Physical examination such as Inspection, and palpation.
• X-ray to check the heel spur and Haglund’s deformity.
• Initially, radiological testing is not needed but if the conservative treatments are failed then an ultrasound and MRI examination may be needed.

What can be the differential diagnosis?

1. Posterior ankle impingement.
2. Haglund’s deformity.
3. Achilles tendonitis.
4. Partial rupture of Achilles tendon.
5. Also, Plantar fasciitis.

Treatment:

Medical treatment includes:

Treatment of retrocalcaneal bursitis focuses on relieving inflammation and pain and preventing complications and future recurrence.

Medication in most cases is a non-steroidal anti-inflammatory drug that can help relieve pain and inflammation.

In severe pain, there is ultrasound-guided steroid injection can also be used.

Surgical treatment:

Keyhole surgery or in complex cases open surgery may also be done. Although uncommon, retrocalcaneal bursitis may necessitate a bursectomy, which involves removing the bursae from the back of the ankle.

Prevention:

modify the footwear to reduce pressure on the back of the heel. Keep extra cushion under your heel in your footwear to maintain the heel’s raised position, so that your Achilles tendon becomes relaxed.

Physiotherapy treatments include:

Icing:

In the acute phase (up to 6-7 days) ice can be used at the heel to relieve pain and control the swelling. Icing can be performed 4-5 times for 15-20 minutes each time.

You can also use contrast baths.

Kinesio Taping:

Kinesio tape can aid in pain reduction.

Manual therapy:

Joint mobilization for correcting the foot alignment.

Stretching:

Stretching the Achilles tendon gradually and repeatedly could help reduce pressure on the bursa.

Strengthening exercises:

Resisted ankle dorsiflexion and plantar flexion (use Thera-band to apply resistance). Resisted ankle inversion and eversion. You can increase the resistance by changing the thera-band to higher resistance.

Non-weight-bearing exercises like Supine wall slides.

Weight-bearing exercises like:

Calf raises. In addition to progress gradually increase the number of repetitions and sets.

Single leg calf raises.

Neuro-muscular training:

Single-leg balancing on the ground, which is progressed by switching to unstable surfaces like wobble cushions, wobble boards, Bosu balls, etc.

Also, Single leg standing neuromuscular control ball throws exercises. This can be progressed by switching to an unstable surface and increasing the weight of the ball.

Sports-Specific Physiotherapy treatment:

Therapeutic Modalities:

1. Firstly Therapeutic Ultrasound.
2. Secondly ESWT.
3. Thirdly SIS.
4. High-intensity Laser. etc.