The calcaneal bursa and heel bursitis

Bursae are small, fluid-filled sacs that reduce friction. Around the back of the heel, one lies between the Achilles tendon and heel bone, while another lies between the tendon and skin. Irritation in either area may be described as heel bursitis.

Heel bursitis commonly presents with tenderness, swelling or warmth at the back of the heel. Pressure from a firm shoe counter may hurt, and discomfort can increase with uphill walking, running or repeated ankle movement. Pain in this location may also come from the Achilles tendon, a bony prominence, skin damage or infection, so location alone does not confirm bursitis.

Repeated friction, a rapid increase in loading and tight or poorly fitting footwear can irritate a bursa. Inflammatory joint disease and direct injury are other considerations. A clinician examines the skin, tendon, ankle movement and exact area of swelling to distinguish these possibilities.

Reduce the activity and footwear pressure that provoke symptoms while keeping within comfortable movement. Shoes with a softer or open heel counter may reduce rubbing. A wrapped cold pack can be used briefly for comfort, with a cloth protecting the skin. Avoid forceful stretching or repeatedly pressing the swollen area.

If symptoms persist, a musculoskeletal or physiotherapy assessment can identify loading, footwear and tendon factors. Treatment may include activity modification, graded calf rehabilitation and medicine when medically suitable. An injection is not appropriate for every painful heel; its location and potential effect on nearby tissues require clinical judgment. Aspiration is reserved for selected situations when fluid assessment or pressure relief is relevant.

Arrange a review if pain or swelling keeps returning, walking is becoming difficult, or the area is not improving after reducing irritation. Seek prompt care for spreading redness, marked warmth, drainage, fever, a wound over the heel or rapidly increasing swelling. A sudden snap with loss of push-off strength needs urgent assessment for an Achilles injury.

Ask which bursa or neighbouring structure is tender, whether the Achilles tendon is involved, and which shoe changes suit the location of your swelling. If medicine or an injection is proposed, discuss expected benefits, relevant risks and what activity is safe during recovery.