Heel Bursitis Diagnosis

Before making a diagnosis of retrocalcaneal bursitis, a doctor must rule out other possible problems, such as arthritis or a fracture. A doctor also will try to determine if there are other contributing factors to heel pain, such as Achilles tendinopathy.

See What Is Bursitis?

To make a diagnosis, a doctor will use some or all of the diagnostic tools below.

Heel Bursitis Diagnostic Process

If symptoms do not respond to home treatments, consultation with a doctor is recommended. Only a doctor can make a definitive diagnosis of heel bursitis and prescribe medical treatment. A doctor’s appointment will include a:

Patient interview

A doctor will ask about medical history, the onset of symptoms, the pattern of pain and swelling, and how symptoms affect lifestyle. For example, doctors may ask a patient what type of shoes they wear and what they do for exercise. The doctor will also ask if home treatments have been tried and if they helped.

Physical exam

A doctor will examine the patient’s foot, noting swelling, tenderness and pain points, and range of motion. The doctor also may ask the patient to point and flex the feet and stand on his or her toes.

The patient interview and exam are essential for making an accurate diagnosis and recommending effective treatments.

Medical imaging

If heel pain has not responded to first-line treatments, or if the doctor wants to rule out another condition, medical imaging may be ordered. Examples of medical imaging include:

• X-rays
• Ultrasound
• MRI

X-rays can show abnormalities of the heel’s calcaneal bone. Abnormalities, such as bone spurs or a Haglund deformity, can affect the heel’s biomechanics and increase the risk of bursitis.

An MRI or diagnostic ultrasound may be ordered if the physician suspects or wants to rule out a problem with the Achilles tendon itself, such as tendonitis or a tear.

Aspiration and Lab Tests

If septic heel bursitis is suspected, a doctor may remove fluid from the bursa with a needle and syringe. This procedure is called a bursal aspiration. It is an outpatient procedure done with a local anesthetic.

The aspirated fluid or a blood sample may undergo lab testing. A doctor may order a:

• Gram stain of the aspirated fluid to determine if certain troublesome bacteria are present. Not all bacteria can be identified with a Gram stain, however, so even if the test comes back negative, septic bursitis cannot be completely ruled out.
• White blood cell count of the aspirated fluid to determine if there are an elevated number of white blood cells in the bursa’s synovial fluid. A high count indicates an infection.
• Glucose level test of a blood sample to determine how much sugar is in the blood. A glucose level that is significantly below healthy range may indicate infection.

Occasionally, all lab tests results come back negative even when an infection is present.¹Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016 Jan;25(1):158-67. Epub 2015 Nov 11. Review. PubMed PMID: 26577126. DOI: 10.1016/j.jse.2015.08.032^,2Gowe I, Parsons C, Best M, Parsons E, Prechter S, Vickery S. Successful Treatment of Olecranon Bursitis Caused by Trueperella bernardiae: Importance of Environmental Exposure and Pathogen Identification. Case Rep Infect Dis. 2018;2018:5353085. Published 2018 Sep 4. DOI:10.1155/2018/5353085^,3Truong J, Mabrouk A, Ashurst JV. Septic Bursitis. 2021 Jan 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29262131 Therefore, a doctor who strongly suspects septic bursitis may prescribe antibiotics without definitively positive lab tests.

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Bursal aspiration also relieves uncomfortable pressure in the heel and may be recommended for treatment.

See What Is Arthrocentesis (Joint Aspiration)?

While medical imaging and lab tests are available, doctors are often able to diagnose heel bursitis after only a patient interview and exam.

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