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Ankle Pain

Retrocalcaneal Bursitis

Minute Read


Posted 9 months ago


Last updated: 03/12/2022


by James McCormack

The retrocalcaneal bursa sits on the back of the heel bone between the calcaneus bone and the Achilles Tendon. A bursa is a fluid-filled sac whose primary function is to act as a cushion between the tendon and the bone. When inflamed, the retrocalcaneal bursa can become painful and is known as Retrocalcaneal Bursitis.


The symptoms of Retrocalcaneal Bursitis include localised swelling at the back of the heel bone that can be exquisitely tender to touch or too painful to place inside a shoe.

It is painful to walk upstairs, walk up a hill or to lift the foot into dorsiflexion while the patient reports feeling a burning sensation on the back of the ankle.

Retrocalcaneal Bursitis Diagram


Causes of Retrocalcaneal Bursitis

Retrocalcaneal Bursitis is primarily caused by repetitive or sudden overuse of the Achilles Tendon through activities such as walking uphill, running or jumping.

In some cases, tight shoes can compress the bursa, causing it to inflame, while blunt trauma such as a kick to the heel while playing sport can also cause Retrocalcaneal Bursitis.

You are more likely to develop Retrocalcaneal Bursitis if you have a Haglund deformity or if you are over the age of 65.

Other systemic conditions can increase your risk of developing Retrocalcaneal Bursitis, such as:

  • Gout
  • Psoriatic Arthritis
  • Inflammatory Arthritis
  • In rare cases, Retrocalcaneal Bursitis can be caused by a bacterial infection. This is usually treated with antibiotics prescribed by your doctor.

Diagnosis of Retrocalcaneal Bursitis

A Physician or Physical Therapist can diagnose Retrocalcaneal Bursitis through a clinical assessment. If they are uncertain of the diagnosis, you may be referred for an Ultrasound scan or an MRI to identify swelling within the Retrocalcaneal Bursa. An x-ray helps identify a Haglund’s deformity, but it cannot be used to diagnose Retrocalcaneal Bursitis.

Home Treatment for Retrocalcaneal Bursitis

In acute episodes of Retrocalcaneal Bursitis, home treatment is effective at resolving the issue. We recommend the following:

  • Ice the back of the ankle for 10-15 minutes 3-4 times daily
  • Rest from impact activity
  • Take anti-inflammatories
  • Wear shoes with a heel raise and soft heel cup
  • Wear a compression sock to manage to swell

Physical Therapy for Retrocalcaneal Bursitis

Following a Physical examination, a therapist can identify any muscular imbalances or an overload to the Achilles Tendon that may be contributing to your pain.

Alongside home treatment methods, stretching and isometric strengthening exercises are beneficial for reducing pain levels and addressing the causes.

If you are keen on running or training for an event, discussing your training plan with your Physical Therapist to create a suitable return to play plan is essential.

Advise on footwear and insoles is beneficial as running shoes with a high heel drop can offload the Retrocalcaneal Bursa and the Achilles tendon, or a simple shoe insert with a heel raise can provide effective results.

In a minority of cases that do not settle with Physical Therapy, an ultrasound-guided corticosteroid injection may be required. The purpose of the injection is to reduce the inflammation levels in the bursa that are causing most of the pain. There are some risks of infection associated with an injection, so these should be discussed with your Physician before any treatment. A period of 1-2 weeks in a walker boot may be recommended.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

Related Article: Insertional Achilles Tendonitis

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