Achilles Bursitis: Causes, Prevention, and Treatments

What is Achilles Bursitis?

Achilles bursitis, also known as retrocalcaneal bursitis, is a condition characterized by inflammation of the bursa located near the Achilles tendon. The Achilles tendon, as described by Dr. David Redfern, an Orthopaedic surgeon based in London, Surrey, and Hove, is a significant tendon situated behind the ankle. This large tendon plays a crucial role as it connects the strong calf muscles to the heel bone (calcaneum).

In the case of Achilles bursitis, the inflammation typically occurs in the bursa that lies between the Achilles tendon and the calcaneus. This small, fluid-filled sac helps to reduce friction as the tendon moves during activities like walking, running, or jumping. When this bursa becomes inflamed, it can cause pain and swelling at the back of the heel, making it difficult to engage in regular physical activities.

This condition is particularly prevalent among athletes but can affect anyone who engages in activities that put excessive stress on the feet and ankles. 

Research published by the NIH offers significant insights into the frequency of the condition. In a detailed study examining 100 ankles, findings showed that retrocalcaneal (RC) bursitis occurred in 28% of the cases. This condition often manifests alongside other complications; for instance, Achilles tendon (AT) enthesitis was present in 22% of the ankles. Notably, both conditions coexisted in 12% of the cases examined. 

What Causes Achilles Bursitis?

Achilles bursitis is primarily caused by repetitive stress and trauma to the heel area. Below are detailed descriptions of common factors that can lead to this painful condition:

Overuse of the Achilles Tendon

Engaging in activities that require frequent foot movements such as running, jumping, or even walking extensively can lead to overuse of the Achilles tendon.

“Achilles tendon also facilitates downward ankle movement, which is essential for propelling the body forwards during activities such as walking and running.” Dr. David Redfern says. This repetitive motion can strain the bursa, leading to inflammation and pain.

Inappropriate Footwear

Wearing shoes that do not provide adequate support or cushioning can increase the risk of developing Achilles bursitis. High heels, which place undue stress on the heel and surrounding areas, or poorly fitting athletic shoes that fail to cushion the heel properly, are significant contributors to the condition.

Sudden Increase in Physical Activity

A rapid increase in the intensity or duration of physical activities without adequate conditioning can shock the tissues around the heel, including the bursa. This sudden change can result in inflammation and discomfort, typically seen in individuals who suddenly enhance their workout intensity without proper gradual training.

Physical Conditions and Anatomical Factors

Certain physical conditions such as flat feet or a high arch can alter the alignment and motion of the foot. These abnormalities can put additional strain on the Achilles tendon and the bursa, potentially leading to bursitis.

Understanding these causes can help in taking preventive measures such as choosing the right footwear, gradually increasing the intensity of physical activities, and addressing any underlying physical conditions. By managing these risk factors, individuals can significantly reduce the likelihood of developing Achilles bursitis.

Diagnosing Achilles Bursitis

Diagnosing Achilles bursitis accurately is crucial for effective treatment. Here's how medical professionals typically determine if a patient is suffering from this condition:

• Clinical Examination: Initially, your healthcare provider will conduct a thorough examination of your foot. They will look for signs of swelling, redness, and warmth around the heel. A detailed discussion about your symptoms and any recent changes in activity levels helps to form a preliminary diagnosis. The doctor may also perform specific movements or apply pressure to the affected area to evaluate pain and swelling directly.
• Ultrasound: An ultrasound is a non-invasive diagnostic tool that uses sound waves to create images of the inside of your body. It is particularly useful for visualizing soft tissues like the bursa. In cases of Achilles bursitis, an ultrasound can show swelling or inflammation of the bursa and help distinguish it from other conditions like Achilles tendinitis.
• MRI (Magnetic Resonance Imaging): While more expensive and less commonly used for initial diagnosis than ultrasound, MRI can provide a detailed image of the Achilles tendon, bursa, and surrounding structures. This method is particularly helpful if the diagnosis remains unclear or if treatment has not led to expected improvements. MRI can help rule out other injuries such as tendon tears or bone abnormalities.

Understanding the diagnostic process can empower patients to seek help early when symptoms first appear, potentially preventing more severe complications.

Treatment Options for Achilles Bursitis

Effective management of Achilles bursitis involves a combination of home remedies and professional medical treatments. Here are the most commonly recommended strategies:

Rest and Ice

The first line of treatment typically involves resting the affected foot to reduce further irritation to the bursa. Ice packs applied to the heel for 15-20 minutes several times a day can help reduce swelling and alleviate pain.

Anti-inflammatory Medications

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and swelling. However, these should be used cautiously and for short periods as they can have side effects.

Physical Therapy

Engaging in physical therapy is a critical component of treatment for Achilles bursitis. A physical therapist can teach you exercises to strengthen the surrounding muscles and tendons, which helps alleviate pressure on the bursa. They may also use techniques such as ultrasound therapy, soft tissue massage, and stretching exercises to improve flexibility and reduce inflammation.

Surgical Options

Surgery is considered only when conservative treatments fail to relieve symptoms. The procedure typically involves removing the inflamed bursa or making small adjustments to the heel bone to reduce pressure on the bursa.

Each treatment option should be tailored to the individual's specific symptoms and overall health. It's important to discuss all available treatment strategies with your healthcare provider to determine the best course of action for your situation.

When to See a Doctor

While many cases of Achilles bursitis can be managed with home care, there are certain situations where professional medical advice is necessary. Recognizing these signs and seeking timely medical attention can prevent the condition from worsening. Here are symptoms and scenarios when you should consult a healthcare provider:

• Persistent or Worsening Pain: If the heel pain does not improve with rest and home treatments within a week, it’s advisable to see a doctor. Persistent pain could indicate a more severe condition or the need for a different treatment approach.
• Severe Swelling and Redness: Excessive swelling or redness around the heel, especially if it’s warm to the touch, could signify an infection or more severe inflammation that requires medical attention.
• Difficulty Walking: If you find it challenging to walk or bear weight on your foot without significant pain, this could indicate that the bursitis has progressed, possibly affecting other structures in the foot.
• Symptoms After a Change in Activity: If you recently changed your workout routine, footwear, or increased your activity level and subsequently developed heel pain, consult with a healthcare provider to evaluate your foot health and activity plans.

It's important to consult with a healthcare professional for a proper diagnosis and treatment plan. For an initial assessment, consider using the Symptom Checker to identify your symptoms. Remember, online tools are not a substitute for professional medical advice.

Prevention Tips

Preventing Achilles bursitis involves taking proactive steps to minimize stress on the heel and Achilles tendon. Here are effective strategies to help you avoid this painful condition:

• Proper Footwear: Choosing the right shoes is crucial, especially for athletes or individuals who engage in frequent physical activities. Shoes should provide adequate heel cushioning and support. For those with specific foot conditions like high arches or flat feet, customized orthotic inserts can offer additional support and distribute pressure more evenly.
• Stretching Exercises: Regular stretching can improve flexibility and reduce tension in the Achilles tendon and surrounding muscles. Focus on calf stretches, Achilles tendon stretches, and plantar fascia stretches. Performing these exercises both before and after physical activities can warm up the tissues and prevent injuries.
• Gradual Training Increments: Whether you are a seasoned athlete or a beginner, increasing the intensity or duration of your workouts gradually is essential. The commonly recommended “10% rule,” which suggests not increasing your activity level by more than 10% per week, can be a useful guideline to follow.

By incorporating these preventive measures into your daily routine, you can significantly reduce your risk of developing Achilles bursitis. Maintaining flexibility and strength in the feet and ankles is also crucial for overall foot health.