Bursitis accounts for 0.4% of all visits to primary care clinics. The most common locations of bursitis are the subdeltoid, olecranon, ischial, trochanteric, and prepatellar bursae. The incidence of bursitis is higher in athletes, reaching levels as high as 10% in runners. Approximately 85% of cases of septic superficial bursitis occur in men. A French study aimed at assessing the prevalence of knee bursitis in the working population found that most cases occurred in male workers whose occupations involved heavy workloads and frequent kneeling. Mortality in patients with bursitis is very low. The prognosis is good, with the vast majority of patients receiving outpatient follow-up and treatment.
High impact activity, such as running. Trauma to the heel such as jumping from a height. Increase in training levels. Lack of shock absorbency in the trainers worn. Worn running shoes. Poor biomechanics. Loss of the fat pad under the heel. Increase in weight.
Pain or tenderness at the back of the heel around the Achilles region. Increased pain during activities with strong, repetitive calf contractions, walking (uphill), stair climbing, running, jumping. Pain may be worse with rest after activity (that night or the next morning) or at the beginning of the excercise. Pain when wearing shoes and the heel is getting rubbed. Bump forming on the back of the heel. Limping. Stiffness. Decreased range of motion. Redness and warmth (if the bursa gets infected).
Your doctor will check for bursitis by asking questions about your past health and recent activities and by examining the area. If your symptoms are severe or get worse even after treatment, you may need other tests. Your doctor may drain fluid from the bursa through a needle (aspiration) and test it for infection. Or you may need X-rays, an MRI, or an ultrasound.
Non Surgical Treatment
Gradual and progressive stretching of the Achilles tendon. Exercises to strengthen and support the ankle. Rest or reduced weight bearing activities. Immobilisation in a cast for 4-6 weeks for severe cases. Ice. Proper fitting and supportive footwear. Massage. Joint mobilisation. Anti-inflammatory medications: only if this does not have adverse results with the patient's current medication. Heel pads and heel lifts. Footwear Advice. Strapping and padding Orthoses/innersoles. The orthotics prescribed and designed by the podiatrists at the Heel and Arch Pain Clinic (affiliated with Beyond Podiatry) are made to align the foot in the correct posture. Surgery is indicated in severe cases when conservative treatment has not resolved the problem.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.