Common Foot Ailment – ‘Subcutaneous Calcaneal Bursitis’
A properly functioning heel is essential to normal, smooth, and painless gait. The heel is the first area to strike the ground during normal gait, which means it takes the brunt of the stress incurred during walking and running activities. Of course, this also means that the heel is highly prone to injury. One such injury is called heel bursitis.
Subcutaneous Calcaneal Bursitis is a condition that causes heel pain. This pain radiates from the bursa located between your Achilles tendon and skin. A bursa is a fluid-filled sac. Your body has many of them. They are found in areas where rubbing may occur, such as between tendons and bones. The fluid inside them helps ease friction during movement.
What causes subcutaneous calcaneal bursitis?
This type of bursitis is mainly caused by wearing shoes that don’t fit properly. Tight-fitting shoes that rub the back of the heel can irritate the bursa. Women who wear high-heeled shoes are most at risk for this condition. Athletes who wear ill-fitting shoes may also suffer from it.
Symptoms of subcutaneous calcaneal bursitis
Pain and swelling in the heel are typical symptoms. You may also notice redness. Certain shoes, such as tight-fitting ones, may be painful to wear.
Treatment for subcutaneous calcaneal bursitis
The aim of treatment is to ease symptoms so that the bursa has time to heal.
Treatment choices include:
- Rest. You may need to alter or limit activities that cause heel pain. These include high-impact activities like running.
- Over-the-counter pain medicine. This helps reduce pain and swelling.
- Cold or heat packs. Putting ice or a heating pad or pack on the heel may ease pain.
- Shoe inserts or padding. Devices such as heel cups or pads for the back of the heel can ease discomfort when moving.
- Footwear. You should avoid wearing tight-fitting shoes or those that rub the back of the heel. Shoes with an open-back heel, such as clogs, may help.
- Stretching exercises. Gentle stretching movements can restore range of motion in the ankle and foot. They can also help with pain.
What Complementary Therapy is helpful?
Soft Tissue Massage
Are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms. Soft tissue massage (particularly to the calf muscles), joint mobilisation (of the ankle, subtalar joint and foot)
What is retrocalcaneal bursitis?
Retrocalcaneal bursitis is a condition characterised by tissue damage and inflammation of the retrocalcaneal bursa (a small fluid filled sac located at the back of the heel) causing pain in the heel region.
A bursa is a thin fluid filled sac found in various places throughout the body. Bursae are designed to reduce friction between adjacent layers of tissue and are filled with lubricating fluid. They are typically located in regions of the body where tissue layers may rub against each other or against bony prominences (figure 1).
Anatomy of Retrocalcaneal Bursitis
The muscle group at the back of the lower leg is commonly called the calf. The calf comprises of 2 major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon. Between the Achilles tendon and the heel bone lies a bursa known as the retrocalcaneal bursa.
During contraction of the calf muscle, tension is placed through the Achilles tendon and this rubs against the retrocalcaneal bursa. Compressive forces and friction may also be placed on the retrocalcaneal bursa during certain ankle movements or by wearing excessively tight shoes. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. This condition is known as retrocalcaneal bursitis.
Signs and symptoms of retrocalcaneal bursitis
Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. Pain is typically experienced during activities requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes).
Often pain may be worse with rest after these activities (especially that night or the following morning). The pain associated with this condition may ‘warm up’ with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region.
Contributing factors to the development of retrocalcaneal bursitis
There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a therapist and may include:
- Poor foot biomechanics (particularly flat feet)
- Inappropriate footwear (e.g. excessively tight fitting shoes)
- Muscle weakness (particularly the calf, quadriceps and gluteals)
- Muscle tightness (particularly the calf)
- Joint stiffness (particularly the ankle, subtalar joint or foot)
- Bony anomalies of the heel bone
- Inappropriate or excessive training or activity
- Inadequate recovery periods from sport or activity
- Inadequate warm up
- Inadequate rehabilitation following a previous Achilles injury
- Change in training conditions or surfaces
- Inappropriate running technique
- Inadequate fitness
- Poor pelvic and core stability
- Poor proprioception or balance
- Being overweight
Call Healthy Harmony today to help make your foot pain go away.