Retrocalcaneal Bursitis

[physiobob]

Definition

Retrocalcaneal bursitis is an inflammation of the bursa at the back of the heel bone (calcaneus). This causes pain with up-and-down movements of the foot.

A bursa is a fluid-filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle.

The retrocalcaneal bursa is located in the back of the ankle by the heel, where the large Achilles tendon connects the calf muscles to the heel bone (calcaneus).

Causes

Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for Achilles tendonitis.

Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.

Comments: As you can see form above the cause is a mechanical one, excessive movement of the rear foot in your shoes. This could be due to the footwear, your walking or running style etc etc. Of course to much to soon is also a possibility as is a reduced healing potential of the body for any other reason. We are constantly renewing body tissues 24hrs a day and if that ability is affected in anyway e.g. diet, rest, another system talking all the 'energy', then other area can break down instead of healing as per normal.

In your case rest and ultrasound is only addressing the symptoms. You need to be assessed for the causes and follow a plan to fix those issues. This is likely to include altered footware, perhaps orthotics, re-structuring of your exercise plan etc. Best of luck

Chronic:

Haglund's deformity

What is Haglund’s Deformity?

Haglund’s deformity is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes.

Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, the deformity is most common in young women who wear pumps.

What Causes Haglund’s Deformity?

To some extent, heredity plays a role in Haglund’s deformity. People can inherit a type of foot structure that makes them prone to developing this condition.

For example, high arches can contribute to Haglund’s deformity. The Achilles tendon attaches to the back of the heel bone, and in a person with high arches, the heel bone is tilted backward into the Achilles tendon. This causes the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to this constant irritation, a bony protrusion develops and the bursa becomes inflamed. It is the inflamed bursa that produces the redness and swelling associated with Haglund’s deformity.

A tight Achilles tendon can also play a role in Haglund’s deformity, causing pain by compressing the tender and inflamed bursa. In contrast, a tendon that is more flexible results in less pressure against the painful bursa.

Another possible contributor to Haglund’s deformity is a tendency to walk on the outside of the heel. This tendency, which produces wear on the outer edge of the sole of the shoe, causes the heel to rotate inward, resulting in a grinding of the heel bone against the tendon. The tendon protects itself by forming a bursa, which eventually becomes inflamed and tender.

Side note for this issue in children: Sever's Disease

Sever's Disease or Calcaneal Apophysitis (Heel Pain in Children)

Description: When recurring heel pain occurs in children, it is usually due to Sever's Disease, while adult heel pain is usually due to heel spurs, plantar fasciitis, or retrocalcaneal bursitis (Haglund's Deformity).

Definitions:

* Apophysitis is an inflammation of a growth plate.
* Calcaneus is the anatomical name of the heel bone.
* Sever's Disease is an inflammation of the growth plate located at the posterior aspect (back) of the heel.

[littlered]

Thanks, what I wanted to know was what exersices can I do to help my ankle. Running up hills just aggrivate it, but I need to get into hill reps to make my running faster.
Can anyone suggest something?

[Judith Mollet]

Thanks, what I wanted to know was what exersices can I do to help my ankle. Running up hills just aggrivate it, but I need to get into hill reps to make my running faster.
Can anyone suggest something?

HI there. It may be a little frustrating for you but read what physiobob has written again. I'll insert here:
Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for Achilles tendonitis.
Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.
Comments: As you can see form above the cause is a mechanical one, excessive movement of the rear foot in your shoes. This could be due to the footwear, your walking or running style etc etc. Of course to much to soon is also a possibility as is a reduced healing potential of the body for any other reason. We are constantly renewing body tissues 24hrs a day and if that ability is affected in anyway e.g. diet, rest, another system talking all the 'energy', then other area can break down instead of healing as per normal.

In your case rest and ultrasound is only addressing the symptoms. You need to be assessed for the causes and follow a plan to fix those issues. This is likely to include altered footware, perhaps orthotics, re-structuring of your exercise plan etc. Best of luck

It is not so sensible to give exercise suggestions without seeing your feet/legs and assessing. If you insist on continuing training (like uphill) you may make the problem worse and you might have to forget your first marathon!! Re-structuring the exercise plan is probably very important!!!!
You don't say what you've done otherwise for sports beforehand and I'm not sure of your age/fitness levels. Not everyone has the same body tolerance for new goals like marathon. See a good sports physiotherapist if your present treatment is not with one. Good luck.

[neurospast]

Ubfortunately for you, you have to start from scratch. What you describe is an active inflamation of a bursa and what you want is to exercise it? As Judith writes a proper assessment might be essential to prevent future problems, reoccurance, a chronic problem. For the time being you might better put your running shoes in the cubboard.

[littlered]

So I have to give up running! I have seen a physio about the bursits she gave me a good going over. I had ran up a hill 2 months before I got to see her, this was what caused the problem. The ultrasound was to get the inflamation over quick. There was an increased improvement from the frist treatment.

I have been running since March last year, cycling for over 5 years. I am 32 years old and am fit.

Training for the marathon was based on adding 10% to the weekly milage. This I have stuck to. I now run 10K every other day and on that particular day I changed to doing hill runs. I included a steep hill and a long incline to my run. It was after that training run I noticed it had sort of flared up again.

I was hoping for some positive replys, but to suggest I put my runners in the cupboard and to start from scratch!!!

Thanks but no thanks for your help

[neurospast]

Both judith as well as physiobob have given you the best support possible. That I wrote to start from scratch, means to stop and to think.
Important is you have a problem which is likely due to biomechanics of the foot and leg. A footscan and analysis will help you more likely than some excercises so cool down and listen.

[physiobob]

I was hoping for some positive replys, but to suggest I put my runners in the cupboard and to start from scratch!!!

Thanks but no thanks for your help

Indeed, no one has bursitis the day, weeks,months, year until they get bursitis. Is is a slowly progressive set of issues that over time can be tipped over the edge, like you did with the long hill run. This means your mechanics weren't great in doing so but that in the past you have been getting away with it. Now that time has passed and so you need to take a look at your running style, footwear, diet etc. Remember you are now getting older as well and tissue regeneration is not as rapid and the tissue itself not as resilient as it once was.

No one is saying stop running, everyone is saying you don't just treat the symptoms, you look for the cause, especially if running is something you have a a passion. The choice is yours suffice to say that this issue will be a recurrent one if you don't look at the big picture

[mIrAge]

littlered,
Hope your heel pain would have settled by now. Perhaps you should tackle this from your running. As a runner, I can recommend you to try some interval work to boost your speed rather than running long hill intervals. Hills make you stronger but speed comes from the turn over or cadence of your legs. In light of you heel probom, unloading the calf and the achilles tendon from long hill effort would have been a good strategy to settle your heel pain. Some ideas to boost your speed are fartleks, tempo runs, yasso 800 and the good old 800m intervals x ?. good luck with running.

[uanto23]

Forget about Surgery, Cortisone Injections, Braces and Splints, Orthotics or Ultrasound Therapy.

I invented this new treatment for myself and I am almost cured in only one month. It will only cost you about 3 dollars and 15 minutes of work everyday.

I know what you are thinking... I must be crazy or trying to sell something. No, this is not an infomercial...

The 3 dollars are for a jar of Vaseline Petroleum Jelly. The rest is a daily massage that you can do it by yourself.

I have had retrocalcaneal heel spur for almost a year. I visited my doctor a couple of times, he suggested stretching exercises, advil, etc. I gained a little flexibility but no improvement in my pain.

Then I decided to tried something new... Researching online I found that the Heel spur is an accumulation of calcified deposit that attaches itself onto the calcaneus. That the tissue surrounding the calcaneus is not very vascular, and the exudate -- a by-product of inflammation -- has very few ways to be carried away from the area. After a period of time, this exudate will calcify (or harden) and, after repeated trauma, greater amounts of this calcified deposit will create what we call heel spur.

I thought: Maybe with massage I would increase blood circulation and hopefully dissolve the calcification. I was not very optimistic but there was not much to lose... the other option (surgery) could be worst. Three days later I realized that I was right on the money. The improvement I had in one week exceeded my expectations.

This is what I do everyday: Before going to bed I use a little vaseline to massage the heel spur and the surroundings areas. I use only my fingers and most of them from both hands. It has to be a deep massage and this requires a lot of work and they got fatigue very quickly.
After one month of this treatment I can see that the bump in the back of my heel is almost completely gone. I could say that I am 70% cured.
I hope that this information could be useful to someone with this problem. It is not life threatening but it diminish your quality of life.

[kmolter]

This reply is directed towards uanto23's comment about treating Haglunds with aggressive daily self massage. I am a marathon runner and have been fighting haglunds for about 15 years and each year it seems to be a little worse. Have you continued to have long term success with your massage treatment? Has anyone else found long term relief from massage?
Thanks!