Pain at the posterior heel or posterior ankle is most commonly caused by pathology at the posterior calcaneus, the Achilles (calcaneal) tendon, or the associated bursae. The following bursae are
located just superior to the insertion of the Achilles tendon. Subtendinous calcaneal bursa. This bursa (also called the retrocalcaneal bursa), situated anterior (deep) to the Achilles tendon, is
located between the Achilles tendon and the calcaneus. Subcutaneous calcaneal bursa. Also called the Achilles bursa, it is found posterior (superficial) to the Achilles tendon, lying between the skin
and the posterior aspect of the distal Achilles tendon. Inflammation of one or both of these bursae can cause pain in the posterior heel and ankle regions.
Normally, only one bursa is in the heel, between the Achilles tendon and the heel bone (calcaneus). This bursa may become inflamed, swollen, and painful, resulting in anterior Achilles tendon
bursitis. Abnormal pressure and foot dysfunction can cause a protective bursa to form between the Achilles tendon and the skin. This bursa may also become inflamed, swollen, and painful, resulting in
posterior Achilles tendon bursitis.
Nagging ache and swelling in or around a joint. Painful and restricted movement in the affected joint. Pain radiating into the neck or arms when bursitis strikes the shoulder (the most common site).
Fever, when associated with an infection.
Gram stain. A lab test called a Gram stain is used to determine if certain troublesome bacteria are present. Not all bacteria can be identified with a Gram stain, however, so even if the test comes
back negative, septic bursitis cannot be completely ruled out. White blood cell count. An elevated number of white blood cells in the bursa's synovial fluid indicates an infection. Glucose levels
test. Glucose levels that are significantly lower than normal may indicate infection.
Non Surgical Treatment
One of the most effective treatments for infracalcaneal bursitis is to temporarily avoid weight-bearing activities that put stress or strain on your heel bone. PRICE (protection, rest, hot/cold
contrast compresses, compression, and elevation) is another good acute management technique for this foot problem. Changing your footwear is an effective long-term prevention and treatment tool for
infracalcaneal bursitis. Footwear that possess a flat support base, a sufficiently wide toe box to accommodate natural toe splay, and a flexible sole are best for preventing and managing
infracalcaneal bursitis. An integrated approach to this problem usually involves the use of padded socks that help reduce pressure, friction, and inflammation in your affected area. Natural
anti-inflammatory agents can also be helpful in quelling inflammation, reducing pain, and improving treatment times for infracalcaneal bursitis. In rare cases, more aggressive treatment methods may
be required, such as cortisone injections or surgery to drain the bursal sac.
Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help