Calcaneal bursitis

Background

Can be subdivided into two separate entities: Retrocalcaneal and Retroachilles bursitis

• Retrocalcaneal bursitis - Inflammation of the bursa located posterior to the calacaneal bone, anterior to the achilles tendon
• Retroachilles bursitis - Inflammation of the bursa located between the achilles tendon and posterior skin, adjacent to the insertion of the achilles tendon on the calcaneous

Clinical features

• Pain localized anterior and 2-3cm proximal to insertion of achilles tendon
• Pain with dorsiflexion
• Tenderness and fullness medial and lateral to tendon

Differential Diagnosis

• DVT
• Gastrocnemius strain
• Retrocalcaneal bursitis
• Retroachilles bursitis
• Septic bursitis
• Septic arthritis
• Calcaneus fracture
• Compartment syndrome
• Friction blister
• Achilles tendon rupture
• Cellulitis
• Superficial thrombophlebitis

Foot diagnoses

Acute

• Foot and toe fractures
• Subtalar dislocation
• Metatarsophalangeal sprain (turf toe)
• Acute arterial ischemia
• Calcaneal bursitis

Subacute/Chronic

• Diabetic foot infection
• Peripheral artery disease
• Plantar fasciitis
• Trench foot
• Ingrown toenail
• Tinea pedis

Management

Conservative management is first-line

• Rest, Ice, Compression, Elevation
• Achilles padding in shoe wear
• Physical therapy → achilles stretching
• NSAIDs
• Bursa aspiration
• Avoid steroid injections secondary to risk of achilles rupture

Disposition

• Typically discharge home

See Also

• Septic bursitis

External Links

• Orthobullets - Achilles Tendonitis

References

Authors

pat Robinson, Neil Young, Ross Donaldson, Jonathan Osgood, Michael Holtz