A 57-year-old woman described having significant heel pain. The pain began gradually each morning, and by the end of the day she was unable to walk without a limp. Symptoms seemed to improve slightly on weekends and during vacations. On examination, she was found to have swelling and erythema on the posterior portion of the heel at the tendon insertion. The bursa was easily palpated, and this action produced pain.
Retrocalcaneal bursitis usually affects middle-aged and elderly patients but can also occur in athletes as a result of overuse. The most common presentation is pain around the insertion of the Achilles tendon. The pain is usually worse at the beginning of an activity such as walking or running, and diminishes as the activity continues. Patients often develop a limp, and wearing shoes may eventually become increasingly painful. On examination, significant swelling and erythema are present. A characteristic enlargement (known as a “pump bump”) may also be present. It may be possible to palpate the retrocalcaneal bursa and a bursa between the tendon and the skin. Direct palpation often reproduces symptoms. A radiograph of the area often shows a calcified distal Achilles tendon or a bone spur on the superior portion of the calcaneus (called a Haglund deformity).
Treatment for this patient involved a diagnostic ultrasound examination, and 3-Dimensional gait analysis, ice orthoses and a course of rehabilitation with a physiotherapist. All of these measures helped to resolve the pain and symptoms for this patient over a short period of time and she is now back to walking without pain.