Identifying the underlying cause of heel bursitis can help determine the best treatment. For example, if the retrocalcaneal bursa is being irritated by a tight Achilles tendon, then the best treatment will be calf stretches to alleviate the tightness.
The possible causes and risk factors for heel bursitis relate to lifestyle, medical conditions, or other factors, such as a previous injury.
Lifestyle Habits that Increase Risk for Heel Bursitis
Certain movements and everyday habits can cause the repetitive heel irritation that triggers bursitis. People with heel bursitis often report one or more of the following:
Using the ankle repetitively
Retrocalcaneal bursitis is often caused by frequent mini-traumas. These mini-traumas are often due to excessive:
Running uphill, which causes the foot to flex considerably, can be especially irritating to the retrocalcaneal bursae.
Ramping up workouts too fast
Starting an exercise program without adequate stretching and muscle conditioning may lead to retrocalcaneal bursitis. Intense exercise can put strain on the calf muscles and the Achilles tendon, including the enthesis, where the tendon attaches to the heel. Strain on the Achilles tendon enthesis can put extra stress on the retrocalcaneal bursa and cause bursitis.
Wearing ill-fitting footwear
Shoes that dig into the back of the heel are the primary cause of calcaneal bursitis. Wearing poorly fitting or too-tight footwear can also cause the retrocalcaneal bursa to become irritated and inflamed.
Dancers and figure skaters—who may be subject to intense training and tight or unsupportive footwear—are at particular risk of heel bursitis.1 One study of competitive figure skaters found 34% had retrocalcaneal bursitis and 30% had signs of calcaneal bursitis.2
Inflammatory Diseases that Increase Risk for Heel Bursitis
Retrocalcaneal bursitis is an inflammatory condition. It is more likely to develop when abnormally high inflammation levels are already present in the body. Certain inflammatory diseases, particularly these forms of arthritis, are associated with heel bursitis:
When an underlying condition triggers heel bursitis, both the bursitis and the underlying condition need to be treated.
Other Factors Increase the Risk for Heel Bursitis
In addition to lifestyle habits and inflammatory disease, many other factors can increase the risk for heel bursitis. These risk factors include:
Foot or ankle deformity
Bone abnormalities and other deformities increase the likelihood of developing retrocalcaneal bursitis. For example, a Haglund deformity—a bony prominence at the back of the heel’s calcaneus—can cause extra friction between the Achilles tendon and the bursa, leading to bursitis.8
Trauma to the back of the heel
Striking the back of the heel against a hard object or other trauma can injure the bursa and lead to bursitis. The injured bursa may become swollen with blood, synovial fluid, or a combination of the two.
When heel bursitis us caused by a trauma, the following steps occur:
- The damaged bursa fills with blood
- The blood irritates the bursa’s delicate lining, causing it to become inflamed
- While the blood in the bursa may be gradually reabsorbed into the body, the bursa’s lining stays inflamed. The inflamed lining produces excess synovial fluid
- The fluid fills the bursa, causing swelling and other heel bursitis symptoms
If a doctor uses a needle and syringe to draw fluid from a bursa after a trauma, the fluid may appear reddish or pink because of the presence of blood.
Infection (septic bursitis)
Heel bursitis can be caused by an infection in of the bursa. This condition is called septic bursitis. While anyone can develop septic bursitis, certain medical conditions, such as diabetes, alcoholism, and rheumatoid arthritis, increase the risk.9,10 Medications that suppress the immune system may also increase risk.
See Septic Bursitis
History of inflammation of the bursa
Patients who have had heel bursitis in the past have an increased chance of getting it again.
There may be more than one reason why the heel bursa is inflamed. In these cases, treatment and prevention strategies should address all of the causes.