The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The Achilles is attached to the heel bone (calcaneus). At the heel bone there is a bursa in front of the Achilles anchor point (bursae tendinis Achilles), as well as behind (bursae subcutanea calcanei). The bursa reduce the pressure against the heel bone.
Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome have also been associated with bursitis.
Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa. Direct pressure on the bursa will exacerbate the pain and should be avoided if possible. Tenderness and swelling which might make it difficult to wear certain shoes on the feet. As the bursa becomes more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a "pump bump", and is usually red, and extremely tender. Swelling can cause difficulties moving as the range of motion in the ankle can be affected. Limping due to the pain may occur. If you press on both sides of the inflamed heel, there may be a firm spongy feeling. Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads. Possibly a fever if you are suffering from septic bursitis (You will need to see a doctor for medication to get rid of the infection). Pain at the back of the heel makes it difficult to continue wearing shoes, especially high heels with straps or shoes that don't fit properly.
When a patient has pain in a joint, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x-rays, although sometimes there are also calcium deposits in the joint that can be seen. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, and crystals, which could indicate gout. In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the correct diagnosis.
Non Surgical Treatment
Many cases of retrocalcaneal and retroachilles bursitis can be treated effectively at home. One of the most important factors is eliminating shoe gear that presses against the back of the heel. Comfortable, supportive footwear and frequently resting the foot will minimize friction at the heel and give the inflammation a chance to subside. These steps, along with other methods to alleviate swelling, such as non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen), icing the heel, and elevating the foot, are usually successful in treating retrocalcaneal bursitis.
Prevention can be accomplished by controlling your foot structure with good supportive shoes or arch supports. Pay attention to early signs of friction like blister formation. This tells you where the areas that are more likely to cause a bursa to form and subsequently a bursitis.