Introduction
A fluid-filled sac that cushions and reduces the friction between the body tissues, such as muscles, tendons, and ligaments, rubbing over the bones is called a bursa. Bursae (plural of bursa) are situated near the large joints such as hips, shoulders, elbows, knees, etc. Inflammation of the bursa leading to pain, discomfort, and limited motion is called bursitis. The bursae located in the calcaneus region include:
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Subtendinous Bursa: The retrocalcaneal bursa is located between the Achilles tendon and the calcaneus bone.
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Subcutaneous Bursa: It is also called Achilles bursa and is located posterior to the Achilles tendon, between the skin and the posterior aspect of the distal Achilles tendon.
What Is Inferior Calcaneal Bursitis?
Inflammation of the bursa behind the ankle, around the calcaneus bone (heel bone), is called inferior calcaneal bursitis. There are three types of calcaneal bursitis, which include: retrocalcaneal (between the Achilles tendon and calcaneus bone) bursitis, subcutaneous (between the skin and attachment of Achilles tendon to the calcaneus bone) bursitis, and sub calcaneal (between the heel bone and plantar fascia) bursitis.
What Are the Causes of Inferior Calcaneal Bursitis?
Some of the causes of inferior calcaneal bursitis include:
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Repeated or overuse of the ankle for long periods of time during running, walking, etc; especially seen in athletes or sportspersons.
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Injury to the calcaneal tendon.
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Wearing tight shoes or exercising in improper-fitting shoes.
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The heel portion of the shoes rubs against the back of the heel.
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Inappropriate training may lead to foot or ankle injuries.
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In some rare cases, a bacterial infection (Staphylococcus) can cause inferior calcaneal bursitis when it enters the body through cuts or open wounds.
What Are the Signs and Symptoms of Inferior Calcaneal Bursitis?
Some of the signs and symptoms of inferior calcaneal bursitis include:
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Pain, swelling, and redness in the posterior ankle region (behind the heel).
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Throbbing pain, especially while removing the shoes, and the intensity of pain worsens when the heel touches the ground during physical activities.
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Tenderness and warmth around the heel region.
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Pain increases on standing on the toes.
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Difficulty in walking, running, jumping, etc.
How Is Inferior Calcaneal Bursitis Diagnosed?
Inferior calcaneal bursitis may be diagnosed by symptoms and a complete physical examination. The doctor examines the heel and the ankle region to check for signs of inflammation, such as tenderness, warmth, and redness. In some cases, the doctor might aspirate the fluid from the inflamed area to check for an infection. An X-ray or MRI (magnetic resonance imaging) scan may be advised to rule out fractures or other serious injuries.
How Is Inferior Calcaneal Bursitis Managed?
Inferior calcaneal bursitis is usually managed with rest, ice, compression, and elevation (RICE therapy), along with physical therapy; however, some severe cases may require surgical management. Conservative management includes the following:
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With the start of symptoms, a rest or decrease in physical activity is advised. If no improvement is noticed, immobilization is done for four to six weeks, and casting can be considered.
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Treatment in the initial phases involves the application of ice packs to the ankle and the heel several times a day, each session lasting for around 15 to 20 minutes. Compression can be achieved by wrapping the area with an elastic bandage and keeping the leg elevated, which reduces pain and swelling.
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Medicines often prescribed to reduce pain and inflammation include NSAIDs (non-steroidal anti-inflammatory drugs)
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such as Ibuprofen, Naproxen, Ketoprofen, and topical Diclofenac.
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Changing footwear to an open-backed shoe or comfortable and supportive footwear to prevent pressure over the affected location, especially athletes suffering from this condition, require frequent changes in their running shoes.
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Orthotic devices help improve the gait and biomechanics of the foot and ankle and reduce irritation.
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Physical therapy forms the mainstay of the rehabilitation program, during which the Achilles tendon is subjected to gradual and progressive stretching, and it helps to relieve the impingement over the calcaneal bursa. The patient is made to stand in front of the wall with the affected foot placed flat on the floor. Then the patient is asked to lean forwards towards the wall until he feels a gentle stretch over the same side of the Achilles tendon. This stretch is maintained for around 20 to 60 seconds and then relaxed. It is performed with the knee extended and flexed, and the stretching cycle must be repeated multiple times in a day to achieve optimal benefit. It is essential to avoid abrupt movements and jerkings so as to avoid exacerbations clinically.
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Ultrasonic or electrical stimulation and microcurrent therapy can also be advised to improve the condition of the patient. As the condition might reduce physical activities, alternate activities may be done to maintain cardiovascular fitness and strength, including swimming and water aerobics.
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Individuals must return to activities only when the bursa heals completely, as the symptoms may flare up again.
Surgical management is required for those patients with progressive and persistent symptoms, even after physical and medical therapy.
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Surgical procedures include excision of the painful bursae and, removing the calcaneus's prominence, debriding the site of insertion of the Achilles tendon. In cases of rupture or avulsion of the Achilles tendon, it can be anastomosed (joined) surgically. It has been demonstrated that an injection of platelet-rich plasma, post-operatively, may improve the outcome.
How Can Inferior Calcaneal Bursitis Be Prevented?
Inferior Calcaneal Bursitis can be prevented by wearing comfortable and supportive shoes. Doing warm-up and stretching exercises before the sports or physical activities. Walking on soft surfaces or avoiding hard or concrete surfaces. Cuts or open wounds in the heel region must be cleaned, and a sterile bandage must be applied to prevent infection.
Conclusion
Inflammation of the bursa around the calcaneus bone is called inferior calcaneal bursitis. It is caused due to the overuse of the heel and ankle region and wearing tight or improperly fitting footwear. It is especially seen in athletes and sports persons. In some rare cases, it can also be caused due to bacterial infections. Inferior calcaneal bursitis is characterized by pain, swelling, and redness in the posterior ankle region and limited movement. It can be treated by conservative management with rest, medications, and physical therapy, or some severe cases may require surgical intervention.
