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Bursitis Of The Foot Surgical Treatments

August 26, 2015
Overview

People suffering from heel bursitis may experience pain and tenderness around the affected soft tissue, pain that worsens with movement or pressure, and visible swelling or skin redness in the area of the inflamed bursa at the back of the heel, which may restrict movement and affect your daily activities. Bursitis is in the heel area is also called Retrocalcaneal Bursitis or Calcaneal Bursitis. The calf comprises of two major muscle groups, both of which insert into the heel bone via the Achilles Tendons. Between the Achilles tendon and the heel bone lies a bursa known as the retrocalcaneal bursa. During contraction of the calf, tension is placed through the Achilles tendon and this rubs against the retrocalcaneal bursa. Treatment of Bursitis is similar to the treatment options for normal heel pain, in particular ice, anti-inflammatories, exercises and orthotics can be beneficial for heel bursitis.

Causes

Retrocalcaneal bursitis is generally caused by local trauma from poorly designed shoes. Patients complain of posterolateral heel pain and may have a posterior heel prominence (?pump bump?), as well as local swelling and tenderness over the Achilles tendon. Pain is increased by squeezing the bursa from side to side and anterior to the Achilles. A heel lift and open-back shoes help alleviate pressure.

Symptoms

Pain when activating the Achilles tendon (running and jumping) and when applying pressure at the point of attachment of the tendon on the heel bone. Contrary to the tenderness occurring with inflammation of the Achilles tendon, the tenderness is localised to the point of attachment to the heel bone.

Diagnosis

If heel pain has not responded to home treatment, X-rays may be ordered. These images can show deformities of the heel bone and bone spurs that have developed at the attachment of the Achilles. If there is swelling and/or pain that is slightly higher and within the Achilles tendon itself, an MRI may be ordered to determine if the tendon is simply inflamed or if there is a chronic tear on the tendon. Aspiration and lab tests. If a septic bursitis is highly suspected, a doctor may perform an aspiration, removing fluid from the bursa with a needle and syringe. In addition to relieving pressure and making the patient more comfortable, it provides a fluid sample that can be tested for infection.

Non Surgical Treatment

The patient with retrocalcaneal bursitis should be instructed to apply ice to the posterior heel and ankle in the acute period of the bursitis. Icing can be performed several times a day, for 15-20 minutes each. Some clinicians also advocate the use of contrast baths. Gradual progressive stretching of the Achilles tendon may help relieve impingement on the subtendinous bursa and can be performed in the following manner. Stand in front of a wall, with the affected foot flat on the floor. Lean forward toward the wall until a gentle stretching is felt within the ipsilateral Achilles tendon. Maintain the stretch for 20-60 seconds and then relax. Perform the stretches with the knee extended and then again with the knee flexed. To maximize the benefit of the stretching program, repeat the above steps for several stretches per set, several times daily. Avoid ballistic (ie, abrupt, jerking) stretches. Other treatment options are microcurrent therapy and corticosteriod injection into the retrocalcaneal bursa. If conservation treatment fails then surgery is indicated.

Surgical Treatment

Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

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