Bodyworks: Calcaneal Bursa

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
Where the tendon joins the calcaneal bone, friction can cause the spaces between the tendon, bone and skin to swell and inflame with bursitis. This constitutes a calcaneal bursa. Apart from swelling over the back of the heel, you’ll feel acute tenderness and pain when you move it or even apply light pressure.

Signs
Your swollen heel may look more red than the other one, and the swelling is often so hard it can feel like bone – partly because it sometimes is, as a bony overgrowth can occur in chronic cases.

Medical investigations
Probably unnecessary, except to exclude differential diagnoses.

Differential diagnoses
Both stress and complete fractures equal a calcaneal bursa in intensity and pain, so must be eliminated by x-ray or scan.

Self-treatment
If you avoid pressure you will ease the pain, so bigger shoes, soft padding, or avoiding heel backs by using sandals or running without shoes can help. Non-steroidal anti-inflammatory tablets and ice are the other staple treatments.

Medical treatment
If physio and self-administered therapy fail, a cortisone injection into the bursa may deflate it, although surgery to remove the bursa and excess bone may be the final solution.

Can you run through it?
With pain, runners sometimes do, but probably at the expense of worsening the bursa.

Recovery time
After surgery, the usual rehabilitation and training downgrade mean that racing will be three to six months away.


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Dear all,
Have just picked up an injury to my heel after two years of being injury free. I think it is a condition called Calcaneal Bursa, an inflammation of the back of the heel
between the tendon skin and bone. Anyone had this injury? How long was your recovery and are you back to full fitness? Complete nightmare as I have just reached my goal of 5 miles four times a week. Injury picked up on a trail! Must invest on a pair of off-road shoes.

Cheers Bloat.

Posted: 03/05/2005 at 16:07

I think what you are describing is Achilles bursitis.

There are two bursas in this area. The first is fairly superficial and located between the skin and the Achilles tendon. This often becomes inflammed from pressure from shoes.

There is also a deeply located bursa (called the retrocalcaneal bursa) which is between the bone (calcaneus) and the Achilles tendon. This can become inflammed either by external irritation or (more seriously) by a partially ruptured Achilles tendon (this is unlikely to be your problem).

It's difficult to say how long this will take to heal without knowing exactly what is inflammed. I would recommend resting for a couple of weeks whilst applying heat treatment and then seeing how it is. To relieve pressure altogether, you could try wearing open backed shoes for a couple of weeks.
Posted: 10/05/2005 at 22:11

Hi,

I'm wondering if anyone can help me out here. I seem to have picked up a slight injury to my heel - i can still run and do sports but i've had it for about 8 months now :(

When i run/play 5 a side etc i can run ok (except on long runs where my heel/achilles area can be a little sore)and afterwards the area can be again a little sore/stiff when moving but this genrally isn't bad and if i walk around seems to go.

I thought maybe i'd just pulled a muscle but i seem to have a 'pressure point' on the heel....the best way i can describe it is if i get my finger and push in a certain small area on my heel it feels tender same applies if i place my heel on something to stretch and i hit that certain spot it aches but goes away when i remove the pressure.

Genrally it isn't too much of a problem at the moment except tightness and tenderness in that area after i run, and if i'm going longer can ache; but as i've had it for a while now and i'm starting to train for the Great North Run i thought i better check it out.

Could it be some kind of small stress fracture?.....i'm not sure and i'm totally guessing!! The pressure point seems to be where the Calcaneal Bursa is on that picture.

Where would be the best places to ask about this?

Any help and advice would be appreciated! :)

Thanks

Jon
Posted: 15/03/2006 at 21:45

Doesn't sound like a stress fracture. If it is a bursa issue, you should rest it for a couple of weeks and see if that helps. Feel free to mail me if you want some more specific advice: workoutpt@yahoo.co.uk.


Posted: 15/03/2006 at 22:51

Jon - it sounds like plantar fasciitis to me. A physio could confirm it for you. There's a big PF thread on here full of sufferers. Feel free to come and join us.
Debbie
Posted: 15/03/2006 at 23:20

Hi

I checked out the planter fascilits page and for me it seems to be in the wrong place.

If i stood with my feet flat on the floor and you looked directly at the back of the ball on my heel, near enough in the centre is where i get a 'pressure point'.

I've just done 30 mins on a running machine and i'm not in pain but if i sit for a while and walk around the back of my ankle area is a little sore for the first few steps and if i press specifically on that 'pressure point' it aches.

It's been like that for ages now; sometimes not bad at all other times abit worse - definatly seems to me to come from that centre point.

If it is Calcaneal Bursa; should i genrally expect it to heal fully if it is rested?.... i'm tempted to go to the doctors and possiblty get referred to a physio..... but i'm far from hobbling in and i don't want to wast anyones time. :)

Cheers

Jon
Posted: 18/04/2006 at 21:27

Can you afford to pay for a private physio, just for a diagnosis? Should be around £30-£40. If you need treatment, then go via your GP but be prepared for a long wait :o(
Posted: 18/04/2006 at 22:14

Jon Carr 2 - what you are describing (pain at rear of heel after sitting) is a classic symtom of Achilles Tendonitis. Presumably the pain subsides after you ve walked a few yards, and i bet its alos sore first thing in morning?

Mine has been relieved sigificantly through stretching - go to a physio and he will confirm and advise. Loads of achilles stretches on the net - get googling!
Posted: 20/04/2006 at 09:02

suffering from something like this myself-but without any redness or swelling...went for a run once in the last six weeks-agony for two days after...also sore first thing in the morning..heard it might be a heel-spur...open for ideas on cure or prevention??????cheers
Posted: 06/05/2006 at 04:49

Orthotics? Have you seen a physio or podiatrist?
Posted: 06/05/2006 at 16:18

I think I may have this. It seems to have come on after a 20 miler. It was fine on the run, but the next day - my heel has stiffened up and its very hard to walk on it.  I walk to work so after a mile or so - I'm not limping and it seems OK - but when I spend any time at my desk - I'm stiff again. 

I've looked in my trainers and theres wear in the heel cup that matches perfectly where I feel the pain in my heel. Its kind of half way up on one side ?

I'm guessing that with distance - this has irritated something ?

Unfortunately - both pairs of my running shoes have the same roughened section in the heel - just on the side thats hurting - so they wont get used again.

Anyone had this ? I'm planning on resting from running for a bit longer - but cant avoid walking really ?  


Posted: 19/04/2011 at 10:30

An inflammed calcaneal bursa will, just like achilles tendinosis/tendinitis, give stiffness through the first steps in the morning and in the warm-up of every run. Then, when your circulation gets going, this stiffness or pain will decrease and go away. In most cases it comes back a while after the run.

Most achilles-tendinitis/-nosis hurts 3-5 cm up from the heel on the achilles-tendon. In some cases the pain is situated on the heel bone itself, in the insertion of the tendon.

Pain due to bursitis is situated on the back of the heel bone(calcaneus) and increases if you apply pressure to it. Try to knock on it with your fist and see if the pain comes with an aching caracter(inflammation).

Bursitits in the deep retrocalcaneal bursa can be differentiated from achilles-tendinitis/-nosis by first knocking on the spot with the tendon stretched, and then afterwards with your foot hanging loose(ex. with your foot hanging over the edge of a a table or chair). Knocking with stretch should give no pain whilst knocking with your foot hanging loose should give aching pain if there is an inflammation in the retrocalcaneal bursa. 

Mechanisms behind injury is often one or several of mentioned below:

- sudden increase in amount of training.

- new shoes

- change in running style (ex. fore-foot running)

- new/different surface of track

OR

- one night with tight shoes with no cussion and hard surface. 

Consult a Naparapath or other practitioner with sports-medicine knowledge for further investigation and treatment if you recognize the symptoms.


Posted: 08/11/2011 at 21:24

Let me say at the outset that most of the previous submissions from my experience are calcaneal bursitis. I as  some others assumed it was tendonitis, because that is a common runner injury. I went to a sports medicine doctor who diagnosed it as calcaneal bursitis, and she gave me stretching and strengthening exercises for the foot and leg. It got better till I did a lot of hiking and some running during the summer. Now I've laid off the running and hiking and do low or non weight bearing exercises at the gym or ride my bike. My question is how long is it going to take to heal? I have been taking it relatively easy for a month. It continually seems to improve, but there is still noticeable sorenes. The swelling is down. I must also add that this has been somewhat chronic. I can remember it off and on for years. Mostly off.  How long should I lay off without pain cessation before I see another doctor?
Posted: 12/01/2012 at 22:29

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