Have you ever felt a deep, throbbing pain in the back of your heel, a pain that seems to radiate and bother you even at rest?
While plantar fasciitis and heel spurs are often the first causes of heel pain, there is another possibility to consider, a problem that can manifest itself insidiously and persistently: bursitis.
This inflammation of a small fluid-filled pouch, strategically located around your heel, can be the source of your suffering, limiting your movement and impacting your quality of life.
Picture this: you put on your favorite shoes, the ones that usually give you optimal comfort, but today you feel an abnormal pressure at the back of your heel, just above where the heel counter exerts a slight friction.
As the day goes on, this sensation turns into a dull, sometimes sharp ache that constantly reminds you of its presence.
Unlike plantar fasciitis, which often has more pain when you wake up, bursitis pain can be more constant and worsen with direct pressure or specific ankle movements.
Heel bursitis, or more specifically retrocalcaneal bursitis, occurs when the bursa between the Achilles tendon and the heel bone (calcaneus) becomes irritated and inflamed.
This usually discreet bursa has the essential role of facilitating the smooth sliding of the Achilles tendon over the bone, thus reducing friction and allowing smooth mobility of the ankle during walking, running and other activities.
However, excessive stress, ill-fitting shoes that cause repeated friction, or direct trauma can upset this delicate balance and lead to painful inflammation of the bursa.
In this article, we’ll dive deep into heel bursitis, highlighting its specific symptoms that can set it apart from other common heel conditions, the various factors that can trigger it, ranging from footwear habits to certain medical conditions, and most importantly, the effective therapeutic solutions available to you to regain a pain-free heel and optimal mobility.
Our goal is to provide you with clear and complete information so that you can better understand the nature of your pain and consider a consultation with a professional podiatrist, a member of our team dedicated to your well-being, to obtain an accurate diagnosis and a personalized treatment plan, adapted to your unique needs.
Heel pain, or talalgia, is a common complaint in podiatry. Although plantar fasciitis is often the cause, other conditions, such as anterior Achilles tendon bursitis (also known as retrocalcaneal bursitis), can also be responsible for this pain.
Identifying bursitis: key symptoms to differentiate it from plantar fasciitis
When faced with heel pain, the first step towards effective relief is to be able to distinguish between retrocalcaneal bursitis and plantar fasciitis, two conditions that, although affecting the same anatomical region, have distinct characteristics.
Accurate identification of symptoms is crucial, as treatment approaches can vary widely.
Plantar fasciitis typically manifests as sharp, severe pain under the heel, often described by patients as a stinging or burning sensation particularly felt during the first steps in the morning or after a prolonged period of rest.
This pain tends to improve slightly with physical activity, and then may recur or intensify after more sustained or prolonged exertion.
The main location of the pain is at the insertion of the plantar fascia on the heel bone.
Heel bursitis, on the other hand, is characterized by pain located more specifically at the back of the heel, just above where the Achilles tendon inserts onto the calcaneus bone.
This pain is often exacerbated by the direct pressure exerted on this area, for example when wearing shoes with a rigid or tight heel counter.
Unlike plantar fasciitis, the pain of bursitis can be more consistent throughout the day and is not necessarily worse in the morning.
Other symptoms that may strongly suggest the presence of heel bursitis:
- Localized swelling and redness: The affected area at the back of the heel may appear visibly swollen, red, and warm to the touch, classic signs of active inflammation.
- Increased sensitivity to palpation: Gentle pressure directly on the back of the heel, especially at the bursa, can cause sharp, severe pain.
- Ankle stiffness: You may feel stiff or limited range of motion of the ankle, especially when bending your back (pulling your toes toward the shin).
- Exacerbated dorsiflexion pain: When you try to pull your toes toward your shin, the Achilles tendon puts pressure on the inflamed bursa, which can intensify the pain in the back of the heel.
It is essential to remember that these symptoms can vary in intensity and manifestation from person to person.
If you recognize several of these signs, it is strongly recommended that you consult a professional podiatrist, a member of our team, for a thorough clinical examination and an accurate diagnosis.
Your podiatrist will be able to do an imaging examination in the clinic using musculoskeletal ultrasound. This medical imaging modality visualizes, among other things, the tendons, ligaments, and bursae in the painful region in order to confirm the diagnosis. Ultrasound can also be used to guide treatment, for example in the case of ultrasound-guided injections, in which the area to be injected is visualized on the screen in order to place the drug in the best possible place for the greatest effect.
Possible causes of heel bursitis: better understanding to act effectively
In order to adopt informed preventive measures and better understand the factors that can contribute to the onset of heel bursitis, it is important to look at the various potential causes of this painful inflammation.
- Overuse and high-impact repetitive activities: Sports and activities that repeatedly and intensely strain the Achilles tendon, such as long-distance running, frequent jumping (basketball, volleyball), or even heavy walking on uneven terrain, can lead to irritation and inflammation of the bursa at the back of the heel.
- Ill-fitting or inadequate footwear: Wearing shoes with a rigid heel counter that repeatedly rubs against the back of the heel, just above the insertion of the Achilles tendon, can exert excessive pressure and cause inflammation of the bursa. Similarly, high-heeled shoes can change the angle of the foot and increase the strain on the Achilles tendon, indirectly contributing to bursitis.
- Direct trauma or repeated shocks: A direct blow or a violent impact to the back of the heel, for example during a fall or a sports impact, can cause acute inflammation of the bursa. Repetitive strain injuries, even of low intensity, can also contribute to the progressive onset of bursitis.
- Structural deformities of the foot: Problems with foot biomechanics such as flat feet (sagging plantar arch) or cavus feet (excessively high plantar arch) can change the way body weight is distributed when walking and running, leading to increased pressure and friction in the Achilles tendon and retrocalcaneal bursa.
- Stiffness or lack of flexibility of the Achilles tendon: A stiff or inflexible Achilles tendon can limit the range of motion of the ankle and increase the strain on the bursa when the foot is flexion and extended. Regular stretching exercises can help prevent this stiffness.
- Underlying inflammatory medical conditions: Certain systemic inflammatory diseases, such as rheumatoid arthritis, ankylosing spondylitis, or gout, can increase a person’s susceptibility to developing bursitis, including in the heel.
Identifying the specific factors that could be contributing to the development of your heel bursitis is an important step in developing a personalized treatment plan and implementing effective long-term prevention strategies.
Relief Strategies and Treatment Options for Heel Bursitis
When faced with the pain and discomfort caused by heel bursitis, there are several steps that can be taken to reduce inflammation and promote healing.
The initial approach usually focuses on conservative methods, aimed at relieving symptoms and allowing the bursa to return to its normal state.
- Rest and limitation of activities that exacerbate pain: The first essential step is to reduce or avoid activities that strain the heel and cause or worsen pain. This may include resting the affected foot for a set period of time, depending on the severity of the inflammation.
- Regular application of ice to the painful area: Applying towel-wrapped ice to the back of the heel for 15 to 20 minutes, several times a day (ideally every 2 to 3 hours), can help reduce inflammation, swelling, and pain.
- Elevation of the affected foot: Elevating the foot, especially during rest periods, can promote fluid drainage and help decrease swelling around the inflamed bursa.
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help relieve pain and reduce inflammation. It is important to follow the recommended doses and consult a health care practitioner if you have any questions or concerns about their use, especially if you have pre-existing health conditions.
- Changing the type of footwear worn: Opt for shoes that are comfortable, well-fitting, have good cushioning and a soft heel counter that doesn’t rub against the back of your heel. Temporarily avoiding high-heeled shoes or those that put direct pressure on the inflamed area can be beneficial. Shoes that are open at the back or those with space at the heel can be especially helpful in reducing irritation.
- Use of heel pads or protective pads: Heel pads can help reduce the strain on the Achilles tendon and retrocalcaneal bursa. Protective felt or gel pads can also be placed around the painful area to minimize friction and pressure from the shoes.
When consulting a professional podiatrist becomes essential for your well-being
If your heel pain persists for more than a few weeks despite the application of these self-care measures or if it worsens, it is crucial to consult a professional podiatrist, a member of our team dedicated to your well-being.
An accurate diagnosis is essential to rule out other potential causes of your pain and to set up a treatment plan tailored to your specific situation.
During your consultation, your podiatrist will perform a thorough clinical examination, assessing the exact location of your pain, the presence of swelling, redness or warmth, as well as the range of motion of your ankle.
They may also ask you detailed questions about your medical history, daily activities and sports, and the type of shoes you usually wear.
In some cases, additional tests, such as an X-ray, may be necessary to rule out other bone or joint problems.
Depending on their clinical assessment, your podiatrist may recommend one or more of the following treatment options:
- Custom-made foot orthotics: Designed specifically for the unique shape of your feet, orthotics can help correct the biomechanical issues that contribute to bursitis and reduce pressure on the retrocalcaneal bursa when walking and running.
- A specific stretching exercise program: Gentle and regular stretching of the Achilles tendon and calf muscles can improve flexibility and reduce strain on the bursa. Your podiatrist will be able to show you the exercises that are most appropriate for your state of health.
- Corticosteroid injections: In some cases of persistent and very painful bursitis, an injection of corticosteroid directly into the inflamed bursa may be considered to quickly reduce pain and inflammation. However, it is important to note that this is usually not a long-term solution and repeated injections can have side effects.
- Physical therapy: A physical therapist who specializes in musculoskeletal conditions can offer manual therapy techniques, specific muscle-strengthening exercises, and treatment modalities like ultrasound or shockwave therapy to promote healing and improve the function of your ankle and foot.
- In rare cases, surgery: If the bursitis is chronic, severe, and other conservative treatments have not provided sufficient relief, surgery to remove the inflamed bursa (bursectomy) may be considered as a last resort.
Do not hesitate to make an appointment with our team of professional podiatrists at the service of your well-being.
We are here to listen to you, assess your condition and offer you the most suitable solutions to help you regain a pain-free heel and optimal mobility.
Don’t let bursitis slow you down, take back control of your steps!
Heel bursitis is a painful condition that, although less often mentioned than plantar fasciitis, can seriously reduce your ability to walk, exercise, and enjoy your daily activities to the fullest.
By learning to recognize the specific symptoms of bursitis and understanding the different factors that can contribute to its onset, you can take proactive steps to achieve effective and long-lasting relief.
Don’t ignore that persistent pain in the back of your heel. Our team of podiatry professionals is here to provide you with an accurate diagnosis and personalized treatments, designed to meet your unique needs and help you regain healthy feet. Your comfort and well-being are our top priority.
To learn more about heel bursitis and the treatment options offered by our team of professional podiatrists at the service of your well-being.
Visit our website: https://podiatreplateau.com/
Don’t wait any longer to make an appointment and rediscover the pleasure of walking without pain.
