Two million men and women are affected by heel pain every year. The pain can disable a person from participating in day-to-day activities such as work and exercising.1 The two forms of heel bursitis are called retrocalcaneal bursitis and subcutaneous calcaneal bursitis.1
Retrocalcaneal bursitis or heel bursitis occurs when the bursa becomes inflamed. The bursa attaches the calcaneus tendon to the Achilles tendon.1
Subcutaneous calcaneal bursitis occurs when the padding of the heel begins to degenerate as a result of trauma.6
Most heel problems are considered to be a mechanical pathology, but arthritic, traumatic, infectious, and vascular pathologies can also be considered.5
Heel pain is a common condition that can be diagnosed by identifying the location of the pain.1 The pain is often near the calcaneal bone in the back of the foot.3
The pain will often worsen as the patient stands or bends their ankle and feet for long periods of time.4
The probability of experiencing heel bursitis increases in active people above the age of 40. Active children ages 8-13 are more likely to develop heel pain as well. 4
Heel pain affects everyone, but it has been reported that mostly runners, tennis players, ballet dancers, and policemen experience heel bursitis.4
To determine the cause of heel pain, doctors must examine the foot and ankle to locate and treat the painful condition.1 Heel palpitations may also be examined to help diagnose heel bursitis.4
The patient’s heel, symptoms and medical history must be examined to diagnose the proper heel condition. Doctors may ask for further imaging of the heel such as an x-ray or MRI scan, but an ultrasound provides the best imaging for heel bursitis.4
Subcutaneous calcaneal bursitis develops in the heel of the foot. Retrocalcaneal bursitis develops directly above the heel.4
The pain from heel bursitis is felt from inside the heel or on the back of the heel. Visual observations of the heel can show bruising, inflammation, abnormal bone placement, and cuts in the skin.4
Long periods of standing and overusing the ankle and feet can lead to retrocalcaneal bursitis.3
Physical activities that include running, jumping, and standing can cause tissue damage and strain on the heel which lead to more serious conditions. Similarly, obesity and excess weight can add pressure on the feet leading to heel pain.4
Constant pressure from uncomfortable footwear and daily activities can cause swelling and pain in the heel resulting in heel bursitis.1
Footwear that scrapes and irritates the Achilles tendon is the most common cause of heel pain.2
The pads covering the heel of the feet become more susceptible to injury due to age and excessive usage of the feet. The pads of the heel wear down and stop providing shock absorption.4
Underlying bone conditions and abnormalities may also cause heel bursitis and other painful disorders.4
Heel bursitis can be caused by, or cause other painful foot conditions such as Achilles tendonitis, Haglund’s disease, and a form of systemic inflammatory arthritis.2 Heel bursitis can also develop calcaneal stress fractures or tumours on the feet.4
What are the symptoms of heel bursitis?
Symptoms of heel bursitis include pain, erythema, redness, and inflammation between the Achilles tendon and the calcaneus.1,2
Heel bursitis can disable a patient from engaging in daily activities such as standing or walking. The pads of the heel begin to ware down and appear red and inflamed.4
Heel bursitis symptoms can be relieved when the pressure affecting the heel is decreased. The pressure on the heel can be relieved by wearing open-heeled shoes or taking anti-inflammatory medication.1
Patients are first advised to rest, ice, and elevate the affected area.3 For the pain and swelling, patients are advised to take NSAIDs (anti-inflammatory drugs).4
Shoes that boost the heel and loosen the shoe counter are proven to help with pain.3
Corticosteroid injections use ultrasound to inject the Achilles tendon and ease pressure on the heel.1
Analgesic medication can also be used to relieve pressure and inflammation in the heel.1
Physical therapy may help calm the tendons and improve the pain.1 Other effective treatments include stretching, orthotics, and night splints.4
If no treatments are effective then surgery may be required to observe the inflamed bursa and treat heel bursitis.5
Open abscission surgery may lead to infection and a slow recovery. Arthroscopic abscission has a faster recovery time and decreased morbidity rates in patients suffering from sub calcaneal bursitis.6
The pain from heel bursitis should improve within a few days of resting and treating the pain. If the intensity of the pain increases, your doctor must be notified instantly.4
One of the most common causes of heel bursitis is excessive running and jumping due to the strain put on the heel. 4
Being overweight can add more pressure on the heel causing it to wear down quickly. Managing weight can help prevent developing heel bursitis.4
Wearing appropriate footwear can absorb stress put on the heel. Worn down heels and soles cause heel bursitis, therefore, wearing fitted shoes can help avoid heel pain.4
Special shoes for each sport and activity are also a necessity when protecting your feet against heel bursitis or other heel conditions.4
Walking barefoot on hard, rocky, or uneven surfaces can damage the heel as well.4
Stretching and warming up before exercise can aid in preventing heel bursitis and other foot conditions.6
Heel bursitis is heel pain that occurs when excessive strain is put on the heel. Microtears, swelling, and degeneration of the heel develop as a result of the strain.
Stretching before working out or standing for long periods of time can help prevent heel conditions. Wearing appropriate footwear can also help to prevent the development of heel bursitis.
Speak with your doctor about any heel pain or swelling you are experiencing. Mild heel pain can be treated by resting, elevating, using ice and using NSAIDs such as ibuprofen.
Diagnosing and treating the condition quickly can prevent the development of other painful heel conditions such as Achilles tendonitis. This article is not medical advice, please consult your doctor for further information.
1. Tu P, Bytomski JR. Diagnosis of heel pain. American Family Physician. https://www.aafp.org/afp/2011/1015/p909.html. Published October 15, 2011. Accessed August 18, 2021.
2. Aldridge T. Diagnosing heel pain in adults. American Family Physician. https://www.aafp.org/afp/2004/0715/p332.html. Published July 15, 2004. Accessed August 18, 2021.
3. Choo YJ, Park CH, Chang MC. Rearfoot disorders and conservative treatment: A narrative review. Annals of Palliative Medicine. 2020;9(5):3546-3552. doi:10.21037/apm-20-446
4. Agyekum EK, Ma K. Heel pain: A systematic review. Chinese Journal of Traumatology. https://www.sciencedirect.com/science/article/pii/S1008127515000437. Published July 17, 2015. Accessed August 18, 2021.
5. Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of HEEL PAIN: A clinical Practice Guideline–Revision 2010. The Journal of Foot and Ankle Surgery. 2010;49(3). doi:10.1053/j.jfas.2010.01.001
6. Yamakado K. Subcalcaneal bursitis with plantar FASCIITIS treated By Arthroscopy. Arthroscopy Techniques. https://www.sciencedirect.com/science/article/pii/S2212628713000042. Published April 18, 2013. Accessed August 18, 2021.
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