Retrocalcaneal bursitis is caused by the inflammation or swelling of the retrocalcaneal bursa, which is located between the anterior aspect of the Achilles tendon and the calcaneous bone (heel). Like the Achilles bursa, the retrocalcaneal bursa is located superior to the insertion of the Achilles tendon. A burse is a fluid filled sac that decreases friction between two tissues
- A direct blow to the retrocalcaneal bursa can produce inflammation and irritation.
- A fall where one lands improperly on the ankle or the retrocalcaneal bursa.
- Constant pressure on the retrocalcaneal bursa from use of the ankle.
- Repeated stress injury to the retrocalcaneal bursa and tendons from a high level of activity, which can also cause tendonitis in addition to bursitis.
- Complications from rheumatoid arthritis, osteoarthritis or gout.
- Infection of the retrocalcaneal bursa or ankle.
- The retrocalcaneal bursa can become swollen as a response to other ankle conditions.
- Pain and tenderness felt over the location of the retrocalcaneal bursa, and concentrated at the back of the ankle by the heel.
- Loss of motion of the ankle
- Pain with activities that stress the retrocalcaneal bursa like walking, jumping, running or activities that cause stress on the tendons that are lubricated by the retrocalcaneal bursa
Avoiding the activities that produce the pain or stress the retrocalcaneal bursa is the first line of treatment.
- Avoiding activities that produce pain or stress of the retrocalcaneal bursa and associated tendons (jumping, running, etc.)
- RICE: (Rest, Ice, Compression, Elevation) should be used to reduce the stress on the retrocalcaneal bursa
- The use of ice to reduce inflammation and pain.
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- Physical Therapy
- Drainage of the fluid in the retrocalcaneal bursa for severe cases. Fluid can be checked for possible infection.
- Antibiotic in the case of infections of the retrocalcaneal bursa
- Steroidal injections in non-responsive cases
- Surgery to remove the retrocalcaneal bursa may be indicated in extreme cases if the problem becomes chronic.
Physical Therapy Interventions
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals. Physical therapy for an ankle bursitis must remain conservative at the onset in order to not aggravate the condition. Emphasis will be in rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and ankle joints.
Common Physical Therapy interventions in the treatment of retrocalcaneal bursitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the ankle. Use of mobilization techniques also helps to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the ankle to support, stabilize, and decrease the stresses placed on the retrocalcaneal bursa and tendons of the ankle joint.
- Neuromuscular Re-education (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, or jumping) of the involved lower extremity to reduce stress on the retrocalcaneal bursa and tendons in daily activities.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold laser, and others to decrease pain and inflammation of the retrocalcaneal bursa.
- Home program including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
In general, patients respond well to conservative treatment of ankle bursitis. It is important that once the pain and inflammation is reduced and motion and strength are restored that the patient gradually returns back to full activities. Instruction in daily activities or sport performance is helpful to reduce the chance of a reoccurrence of the bursitis. In most cases full return to activity will take from 2-6 weeks depending on the severity of the condition. As a preventive measure individuals should:
- Make modifications in work or daily activities and avoid positions that stress the retrocalcaneal bursa or wearing protective equipment to avoid prolonged pressure or unexpected blows on the retrocalcaneal bursa.
- Maintain strength and flexibility to reduce stress on the retrocalcaneal bursa and tendons of the ankle.
- Avoid highly repetitive activities whenever possible.