Lower Leg
Bursitis of the Achilles Tendon

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Achilles tendon bursitis, or retrocalcaneal bursitis, can affect anyone, but is typically a foot condition in athletes, especially runners. Because of similar symptoms, this condition is often confused with Achilles tendinitis. At times, bursitis of the Achilles tendon can occur in conjunction with Achilles tendinitis. When both conditions are present, it is referred to as Haglund's syndrome.

If you are a runner and are experiencing pain in your lower leg and heel area, you may be suffering from Achilles tendon bursitis. Proper treatment of the condition can help relieve the pain and allow your leg to heal.

Causes of Achilles tendon bursitis

Bursitis of the Achilles tendon is caused by the irritation and inflammation of the retrocalcaneal bursa, a small fluid-filled sac located in the back of the ankle that acts as a cushion and lubricant for the ankle joint.

Possible causes of Achilles tendon bursitis include: 

  • Aging: Factors related to the aging process, including the onset of rheumatoid arthritis and gout, can deteriorate the bursa. 
  • Overuse of ankle: Excessive walking, uphill running, jumping, and other aggressive exercise regimens, especially without proper conditioning, can cause irritation to the bursa. 
  • Trauma: Sudden injury to the ankle joint, or trauma caused by rigid or improperly fitted shoes, can increase the chances of developing bursitis.

Symptoms of bursitis of the Achilles tendon

Unlike Achilles tendinitis, which tends to manifest itself slightly higher on the lower leg, Achilles tendon bursitis usually creates pain and irritation at the back of the heel.

Possible signs of bursitis of the Achilles tendon include: 

  • Difficulty to rise on toes: Standing on your toes or wearing high heels may increase the heel pain. 
  • Inflammation and tenderness: The skin around your heel can become swollen and warm to the touch. Redness may be visible. 
  • Pain in the heel: Pain tends to become more prominent when walking, running, or touching the inflamed area. 
  • Stiffness: The back of your ankle may feel a little stiff due to the swelling of the bursa.

Achilles tendon bursitis treatment

Many times, Achilles tendon bursitis can be treated with home care. However, if self-care remedies do not work, your doctor may need to administer additional treatments.

Home care

The most important thing you can do to help your healing is to refrain from activities that could further aggravate the bursitis.

Typical home-care treatments for Achilles tendon bursitis include: 

  • Anti-inflammatory medication: Take over-the-counter pain medication, like aspirin or ibuprofen, to reduce pain and swelling. 
  • Heel wedges: An over-the-counter or custom heel wedge can be placed in your shoe to minimize stress in the Achilles tendon. 
  • Ice: Apply ice or other cold therapy to your sore heel several times a day. 
  • Rest: Limit your activity on the injured leg; avoid putting pressure on it whenever possible. Also, elevate your leg during non-use to help reduce the swelling.

The above remedies may be used on their own or in combination with others on the list.

Physician-administered treatments

If the above self-care remedies are not effective, you should visit your doctor for additional treatment.

Possible Achilles tendon bursitis treatments your doctor may administer include: 

  • Immobilization: If the bursitis is combined with Achilles tendonitis, your doctor may place a temporary cast on the ankle to prevent movement and allow it to heal.
  • Physical therapy: Exercises may be used to improve the ankle's strength and flexibility. 
  • Steroids: Injection of steroids into the retrocalcaneal bursa (not the Achilles tendon) may be necessary.
  • Surgery: In very rare circumstances, surgery may be needed to remove the retrocalcaneal bursa; however, this is typically a last resort.

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