While the majority of cases involving heel pain turn out to be plantar fasciitis, numerous other conditions can cause heel pain. Knowing the difference between them can help you quickly identify and seek the proper treatment for your pain, allowing you to get back on your feet quickly and without complications.
What Is Bursitis?
Bursitis is an inflammatory condition that affects the bursae, or tiny fluid-filled sacs located near the joints in your body. Under normal conditions, these sacs help your joints move smoothly and play a role in protecting and cushioning different parts of the joint as you move, like tendons, ligaments, and muscles. Bursitis develops when these fluid-filled sacs become inflamed, swollen, and painful.
While bursitis can develop at any place in the body where a bursa is located, there are two bursae near the heel that can cause heel pain. The first, known as the retrocalcaneal bursa, is located at the back of your ankle near the heel, where your Achilles tendon meets the end of your calf muscle. The second, known as the Retroachilles bursa, is located between the skin at the back of your heel and the Achilles tendon. When either or both bursae become inflamed and swollen, the condition is known as Retrocalcaneal bursitis or Achilles bursitis.
Common Causes of Retroachilles and Retrocalcaneal Bursitis
Retrocalcaneal bursitis can be caused by many of the same activities that trigger plantar fasciitis or Achilles tendonitis, including overuse from high-impact activities like running or sports that involve a lot of jumping. Uphill running is a particularly high-risk activity for retrocalcaneal bursitis, since the flexed position of the foot during impact means increased contact with the retrocalcaneal bursa. This type of bursitis can also be caused by deformities in the foot, such as Haglund’s deformity, as well as injury or trauma to the foot.
Retroachilles bursitis almost always caused by poorly fitting shoes that rub or dig into the back of your heel. Over time, the Retroachilles bursa becomes irritated, inflamed, swollen, and painful.
Both retrocalcaneal and Retroachilles bursitis are also commonly associated with other conditions that cause trauma to the foot, including Achilles tendonitis, plantar fasciitis, heel spurs, and rheumatoid arthritis.
Symptoms of Retroachilles and Retrocalcaneal Bursitis
Retrocalcaneal and Retroachilles bursitis can occur at the same time, and the symptoms for both conditions are very similar. Visible swelling is the most common hallmark of bursitis, as well as inflammation, redness, and pain that develops gradually. In the case of Retroachilles bursitis, the swelling may actually present as a hard lump at the back of the heel.
Pain will likely increase if you flex your toes, point your feet downward, or stand on tiptoe since these motions squeeze the bursae.
If you notice any of these symptoms accompanied by a fever, it’s important to seek medical help quickly. While unusual, it is possible for the bursae to become infected and even rupture, a serious condition known as septic retrocalcaneal bursitis.
Bursitis or Heel Pain from Plantar Fasciitis?
While the heel pain associated with retrocalcaneal bursitis or Achilles bursitis can be very similar to the pain from plantar fasciitis, there are a few big differences.
Most importantly, the pain from plantar fasciitis is almost always the worst first thing in the morning, and typically improves somewhat as the fascia stretches and warms up. Heel pain from bursitis, on the other hand, is usually better in the morning, only to get gradually worse throughout the day.
Many stretches that help plantar fasciitis will aggravate an inflamed, swollen bursa. If you think you have plantar fasciitis, but find that stretching makes the pain worse, you may want to consider the possibility that bursitis is involved.
Keep in mind that if you have plantar fasciitis or heel spurs, you may be at greater risk for developing bursitis, because of the overlap in risk factors for bursitis that caused your plantar fasciitis to develop (including ill-fitting footwear and overuse of the feet).
Treatment Options and Advice
The majority of cases of bursitis, especially if addressed properly early on, can be treated successfully in the comfort of your own home. Effective, conservative treatment methods include the following:
- Rest. Take a break from any activity that worsens pain
- Ice. Apply an ice pack several times each day to reduce swelling and inflammation in the bursae
- Use NSAIDs as needed for pain and to decrease inflammation
- Wear supportive, comfortable shoes that keep the heel from rubbing or slipping around. Running shoes, which typically have a protective notch for the Achilles tendon, are especially helpful.
- Orthotic inserts can greatly improve the amount of support and cushioning your feet get as you walk and move, and can also help correct gait abnormalities due to an arch weakness that may be exacerbating the strain on your bursae.
If your heel pain and bursitis do not resolve with these conservative treatments, your doctor may recommend medical treatments such as corticosteroid injections, antibiotics, and surgery as a last resort.
While bursitis can be very painful, the good news is that most cases are successfully resolved without medical intervention. By recognizing the signs and paying attention to your body, you can nip bursitis in the bud before it takes a toll on your feet and health.