What is Calcaneal Bursitis?
Calcaneal bursitis, is a condition, characterized by inflammation of the bursa present at the back of the heels. Calcaneal bursitis mainly presents with pain at the heels or at the back of the ankles, where the bursa gets inflamed. A bursa is a fluid filled sac or cushion between muscles and tendons, which is important as a shock absorber and as a lubricant. Inflammation of the bursa of the heel can cause pain, redness, warmth, and can cause difficulty in walking.
Causes of Calcaneal Bursitis
Calcaneal Bursitis is a common condition and usually occurs due to overuse of the ankle or is a result of making repetitive movements of the ankle. Calcaneal bursitis is often seen in athletes and sports persons of all ages; this condition is also common in middle aged and elderly persons. Causes of calcaneal bursitis include strenuous, repetitive activities that exert excess pressure on the bursa, like running, jogging, and jumping activities. Inflammation of the bursa can occur more frequently, on initiation of sports activities or intense workout after long break periods or without proper warm up.
Some Factors That Contribute To The Causes of Calcaneal Bursitis Include:
- Undertaking strenuous sport activities, without proper fitness conditioning or performing in excess can cause calcaneal bursitis.
- Inappropriate footwear when playing, jumping or ineffective sports training can increase the risk of calcaneal bursitis. Use of tight-fitting shoes, high heel shoes can exert more pressure over the back of heels.
- Those having flat feet, any feet deformities, previous injuries, improperly healed injuries, poor rehabilitation or poor core stability can be at increased risk of calcaneal bursitis.
- People with joint stiffness, muscle weakness or muscle tightening, particularly the calf muscles can get easily injured or develop calcaneal bursitis.
- Being overweight or a sudden increase in body weight can contribute to pain in calcaneal bursitis.
Calcaneal bursitis is a result of overuse injury to the soft tissue and bursa of the heel. This commonly occurs in people exposed to repeated traumatic movements, wearing tight fitting shoes; more commonly players. However, this condition can also be seen in people with conditions like rheumatoid arthritis, seronegative arthritis, gout and other forms of musculoskeletal problems. In some cases, it may be a result of injury to the nearby structures and may also be related to the Achilles tendon, which attaches calf muscles to the heel.
Some other conditions that can increase the risk of calcaneal bursitis include osteoporosis, weakening of bones with aging. This increases the chances of joint and soft tissue problems, including calcaneal bursitis. Some occupations that involve using a foot pedal, cause repetitive movements of the ankle and increase the chances of calcaneal bursitis.
In some odd cases, calcaneal bursitis can be caused due to an infection in the bursa, called septic calcaneal bursitis. In this microorganisms are responsible for the inflammation of the bursa, resulting in swelling and pain of the calcaneal bursa.
Signs and Symptoms of Calcaneal Bursitis
Symptoms of calcaneal bursitis may vary from person to person and also depend on the cause of calcaneal bursitis in each case. However there are some symptoms commonly experienced by most of the people experiencing calcaneal bursitis.
Symptoms of Calcaneal Bursitis In Most Cases Include:
Heel Pain – Commonest Symptom of Calcaneal Bursitis
Heel pain is present in almost every case of calcaneal bursitis. Pain in heel on the posterior or back side, is often more when walking, running, jumping or other activities that involve placing weight on the heel. Sometimes, the heel may be painful, even with the slightest touch or pressure. Heel pain can be felt more when standing on the toes, or during repetitive ankle movements
Inflamed Heel – Important Sign and Symptom of Calcaneal Bursitis
Calcaneal bursitis presents with inflamed heel, the symptoms of which include redness over the skin of the heel. Feeling of warmth over the painful heel area is also a common symptom of calcaneal bursitis.
Swelling Over the Heel – Another Sign of Calcaneal Bursitis
Inflamed heel can present with noticeable swelling in some people experiencing calcaneal bursitis. It may appear as a bump in the posterior heel area, which is painful.
Most cases of calcaneal bursitis also present with symptoms, which suggest heel pain on wearing footwear, unable to use certain types of footwear and touch to the inflamed heel is unbearable. Those wearing high heel shoes may develop a stretch in their tendons of the calf and heel and result in calcaneal bursitis. Heel pain in such cases may worsen when they wear high heel shoes or the pain may also be more prominent when they shift to other types of footwear or flat shoes.
Symptoms of calcaneal bursitis, usually worsen when the person first initiates movements after rest period. For example, walking at first in the morning after arising from bed or exerting pressure on the ground after a long period. Heel pain in calcaneal bursitis is also experienced more on the next day after over exertion or excessive sports activities is done. Calcaneal bursitis may be seen on one or both sides; unilateral or bilateral calcaneal bursitis.
While the symptoms of calcaneal bursitis may seem similar to the presentation of other soft tissue conditions, tendonitis, etc. in the nearby region, it is also important to evaluate every case thoroughly.
Diagnosis of Calcaneal Bursitis
Calcaneal Bursitis needs to be properly evaluated and examined to understand the involvement of tissues and bone. Proper history taking and careful examination is done to understand the causes and symptoms of calcaneal bursitis. History of overuse of ankles, repetitive ankle or heel movements, repeated stress or injuries, etc. needs to be considered to assess calcaneal bursitis. Clinical examination of the ankle and the heel, will reveal signs and symptoms of calcaneal bursitis. Heel pain, swelling, redness, warmth, and inflammation in calcaneal bursitis need to be evaluated.
Following this, additional tests may be ordered to confirm the diagnosis of calcaneal bursitis. Some investigations may also be required to rule out other conditions similar to calcaneal bursitis. Investigations related to calcaneal bursitis may include
- X-rays – To detect any bony deformities, injuries to the heel bones, fractures, bone spurs or any other bony defect.
- MRI – To detect the present of soft tissue injuries, associated tendon injuries, tear or inflammation. It may also be done to rule out other possible conditions, depending on the symptoms presented.
Diagnosis of calcaneal bursitis can be made on the basis of history and examination, however, any other associated symptoms may require other investigations. If fever is present, blood tests to detect the presence of infection may be advised. For any history of recent fall or injury, specific investigations of the nearby areas may also be ordered.
Treatment of Calcaneal Bursitis
Treatment of calcaneal bursitis, primarily involves protecting the heel and preventing it from further damage.
- Rest – The person is usually advised rest, or at least required to avoid strain on the heel or strenuous physical activities.
- Ice – Applying ice to the heel can help to relieve pain and reduce swelling; must be done as advised by the physician.
- Pain killers – In order to control inflammation and to treat calcaneal bursitis, anti-inflammatory medications may be given. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may show some side effects; while some may experience gastric disturbances with the use of NSAIDS, these medicines may also be contraindicated in certain medical conditions. Hence, it is better to take these medicines to treat calcaneal bursitis, under medical guidance only.
- Topical medicines – Local application of pain-relieving gel, patches application and other locally applied medicines may be preferred by some to manage pain and swelling in calcaneal bursitis.
- Other medications – Depending on the individual condition, treatment of calcaneal bursitis may include use of specific medicines. Antibiotics may be required in case of septic calcaneal bursitis, as they can be caused by microorganisms. Some people with calcaneal bursitis may be deficient in some nutrients and may require nutritional supplementation, like vitamins, minerals. Vitamin D and calcium may be commonly required in some, to help in management of calcaneal bursitis.
- Fluid aspiration – For some cases of calcaneal bursitis, aspiration of fluid from the inflamed bursa may be considered. In this, a syringe is inserted into the joint and the excess fluid accumulated in the swelling of the bursa is aspirated. This helps to reduce pain, swelling and relieves the pressure. This is a diagnostic and therapeutic procedure. The aspirated fluid can be sent for laboratory analysis to detect the presence of any microorganisms, blood, pus cells or other causes affecting the bursa. Fluid analysis also helps in deciding further treatment plan for calcaneal bursitis. It can help to diagnose and treat septic bursitis.
- Micro current Therapy – This treatment method has shown promising results in treatment of calcaneal bursitis and may be considered, if appropriate.
Orthotics for Treatment of Calcaneal Bursitis
Use of footwear may be modified to reduce stress on the heels. This may include use of heel pads, customized cushions or paddings to manage calcaneal bursitis. Wearing appropriate orthotics can reduce irritation of the heel due to the inflamed bursa.
Use of flat shoes may also be recommended to avoid strain on the heel and relieve the inflamed bursa. However, sudden changes in the footwear pattern can be difficult to manage, hence gradual changes should be done to incorporate the use of comfortable low heel shoes. Shoes that are open at the heel end can help to relieve pressure on the inflamed area. Certain modifications to the existing shoes may be considered, like altering the heel, placing soft cushions, paddings, shoes inserts, etc.
Any ill-fitting or tight-fitting shoes must be replaced with proper, comfortable ones to avoid further problems of calcaneal bursitis. Use of shoes with hard soles or those, which are rigid near the heels can cause damage, hence should be avoided to prevent calcaneal bursitis.
Physical Therapy as a Treatment for Calcaneal Bursitis
Physical therapy may be advised for treating calcaneal bursitis. Various treatment modalities are used in this, which can help to relieve pain, reduce swelling and inflammation and improve the strength and flexibility of the related muscles and tendons. Use of ultrasound, heat and other techniques are popular and it is best decided by the therapist depending on the individual requirement of a person experiencing calcaneal bursitis.
Physical therapy also involves exercises that help to manage calcaneal bursitis and prevent further problems. Physical therapy prescribes therapeutic exercises aimed at strengthening the muscles around the ankles and the heels. Stretching, strengthening and relaxing exercises are included and must be followed as advised by the therapist. This not only helps to reduce pain and swelling but also helps to prevent further injuries to the structures around. Calcaneal bursitis can be prevented by following a regular stretching and strengthening physio therapy program.
Proper warm up and stretching before and after sports activities can help prevent calcaneal bursitis in sports persons and dancers. Physical therapy also trains sports person to realize their potential and avoid overuse of ankles or heels. It is important to maintain balance between activity and rest to avoid injuries and inflamed tissues causing calcaneal bursitis.
Injections to Treat Calcaneal Bursitis
When all the above treatment methods fail to treat calcaneal bursitis in some cases, the physician may consider steroid injections. The ideal case for use of corticosteroid injections as a treatment for calcaneal bursitis is best decided by the physician and not all cases may need this option.
In this procedure, a small amount of corticosteroid is injected into the bursa, taking all aseptic precautions. This helps to relieve inflammation, swelling and helps to reduce pain and irritation. As a precautionary measure, the rest is advised after the injection is given. In order to avoid any damage to the nearby tendons and soft tissue, it is advisable to avoid stretching or strenuous activities that can strain the heel and ankle area. Hence, jumping, playing or running activities are to be avoided. Resting the affected foot for some period is ideal to allow the injection to take effect to treat calcaneal bursitis.
Surgery to Treat Calcaneal Bursitis
When all treatment options for calcaneal bursitis fail, when a person’s calcaneal bursitis continues for long or when the condition worsens, surgical treatment for calcaneal bursitis may have to be considered. Surgical treatment option for calcaneal bursitis involves removal of the inflamed bursa, in a surgical procedure called bursectomy. In this surgery, the inflamed or infected bursa, which is the fluid filled sac is removed. This is done using an arthroscope, which is inserted into the joint and the inflamed bursa is removed.
Other surgical procedures may be required depending on the cause of calcaneal bursitis and the associated symptoms. For example, any foot deformities (if surgical corrections are available for the particular condition), bone spurs, if any may have to be removed surgically and surgical correction of any other changes in the bone or soft tissue causing calcaneal bursitis, may be considered to treat calcaneal bursitis.