Retrocalcaneal bursitis: a practical guide

The retrocalcaneal bursa normally helps the Achilles tendon move over the heel bone. Friction, repeated impact, tight footwear or a change in training can inflame its lining. Symptoms may include tenderness, fullness or swelling behind the heel, with pain during push-off or when the ankle bends. Examination is directed at the bursa, Achilles tendon and heel bone. Because these structures sit close together, a clinician may use imaging when the diagnosis is uncertain or recovery is not following the expected pattern. Joint swelling can be documented as part of the physical assessment.

For a short period, replace running and jumping with lower-impact movement that stays comfortable. Avoid rubbing from rigid heel counters and use footwear that leaves room around the sore area. A wrapped cold pack may calm pain. Medication decisions should account for your other medicines and health conditions; discuss anti-inflammatory medication with a qualified professional. Rehabilitation commonly builds calf and ankle capacity in stages. If conservative care is insufficient, a specialist may discuss aspiration or an injection, with particular care around the Achilles tendon.

Arrange a clinical review if symptoms affect walking, sleep or work, or if they continue after you reduce aggravating activity. Seek prompt medical care for warmth, spreading redness, fever, pus, sudden marked swelling or severe pain. An injury followed by a snap, inability to push off, or inability to bear weight warrants urgent assessment. Breathlessness or sudden calf swelling is also urgent.

Bring a record of activities, footwear changes and the movements that reproduce pain. Ask how the diagnosis was made, whether the Achilles tendon is involved, what rehabilitation stage fits you, and what should prompt an earlier review.