Many cases of retrocalcaneal bursitis can be resolved with home-care that is focused on reducing inflammation. More serious or chronic cases require medical interventions. Rarely, surgery is needed.
Heel Bursitis Home Treatment
Most of the time, heel bursitis can be treated at home. Changing just a few habits can decrease inflammation and allow the bursa to heal. Home treatments for heel bursitis include:
Taking a break from daily walks or an exercise routine may give the inflammation time to decrease and the bursa time to heal.
Icing the back of the ankle for about 20 minutes 2 or 3 times a day may help decrease inflammation, pain, and swelling. Wrap the ice in a towel to avoid damaging the skin.
Avoid wearing shoes with rigid heel and ankle construction and instead wear more supportive, comfortable shoes.
People with retrocalcaneal bursitis may benefit from wearing shoes with an Achilles notch—a groove in the collar at the back of the shoe to protect the Achilles tendon. (Most running shoes are designed with an Achilles notch.) In addition, shoes that provide arch support can take stress off the Achilles tendon, making it less likely for the tendon to uncomfortably rub against the retrocalcaneal bursa. 1 Ma, CB. Bursitis of the heel. MedlinePlus, US National Library of Medicine. Updated August 15, 2018. Acessed January 25, 2021. https://medlineplus.gov/ency/article/001073.htm
People who have calcaneal bursitis, which is typically caused by uncomfortable footwear, may try wearing open-heeled shoes.
Shoe inserts for heel bursitis
Wearing shoe inserts, such as heel wedges, can encourage better foot mechanics and reduce irritation of the retrocalcaneal bursa. 1 Ma, CB. Bursitis of the heel. MedlinePlus, US National Library of Medicine. Updated August 15, 2018. Acessed January 25, 2021. https://medlineplus.gov/ency/article/001073.htm Shoe inserts may be either store-bought or prescribed by a doctor and custom-made.
Heel bursitis stretches
Stretching a tight Achilles tendon will take the pressure off of the retrocalcaneal bursa. Stretches should be gentle and avoid bouncing.
Stretching is not a standard treatment for calcaneal bursitis, which is less likely to be triggered by a tight Achilles tendon.
Medical interventions for Heel Bursitis
If symptoms persist after 2 or 3 weeks of home treatment, a doctor may recommend trying additional treatment strategies. These strategies may include:
Stretches and exercises can improve the health of the Achilles tendon and take pressure off the bursa. To prevent future flare-ups of bursitis, patients are encouraged to continue these stretches and exercises at home even after their heel pain goes away.
Using sound waves, therapeutic ultrasound produces a vibration through the skin that may stimulate blood flow and healing. This heel bursitis treatment is typically painless and most patients do not feel it. Ultrasound treatment may be done by a physician, podiatrist, or physical therapist. 1 Ma, CB. Bursitis of the heel. MedlinePlus, US National Library of Medicine. Updated August 15, 2018. Acessed January 25, 2021. https://medlineplus.gov/ency/article/001073.htm
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Removing fluid from the bursa can relieve pressure at the back of the heel and decrease pain. Fluid is removed from the swollen bursa with a needle and syringe. This procedure is called bursal aspiration.
Bursal aspiration can be done with a local anesthetic in a doctor’s office or hospital. Ultrasound imaging (different than therapeutic ultrasound) may be used to help accurately guide the needle into the heel’s swollen bursa.
See What Is Arthrocentesis (Joint Aspiration)?
A man-made hormone called cortisone can decrease inflammation in the body. A cortisone injection in the heel may quickly decrease the inflammation associated with retrocalcaneal bursitis.
While cortisone injections may effectively eliminate painful symptoms, some research suggests they are associated with a degeneration of the Achilles tendon. 2 Hugate R, Pennypacker J, Saunders M, Juliano P. The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons. J Bone Joint Surg Am. 2004 Apr;86(4):794-801. PMID: 15069146 DOI: 10.2106/00004623-200404000-00019 , 3 Chechick A, Amit Y, Israeli A, Horoszowski H. Recurrent rupture of the achilles tendon induced by corticosteroid injection. Br J Sports Med. 1982 Jun;16(2):89-90. PubMed PMID: 7104562 DOI: 10.1136/bjsm.16.2.89 , 4 Jones JG. Achilles tendon rupture following steroid injection. J Bone Joint Surg Am. 1985 Jan;67(1):170. PubMed PMID: 3968099. To lower the risk of a tendon injury, patients are advised to temporarily avoid stretching, squatting, and running. Some physicians may recommend wearing a cast to temporarily immobilize the heel and ensure the Achilles tendon and its enthesis are protected.
See Cortisone Injections (Steroid Injections)
Since cortisone may cause tissue damage, newer treatments, including platelet-rich plasma and other regenerative medicine techniques, are sometimes recommended. Research about whether these treatments are effective is ongoing.
In addition, many experts advise caution when considering corticosteroid injections because they carry a small risk of introducing bacteria, which can lead to septic bursitis. 5 Truong J, Mabrouk A, Ashurst JV. Septic Bursitis. [Updated 2020 Sep 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470331/
See Cortisone Injection Risks and Side Effects
Antibiotics (for septic heel bursitis)
Septic bursitis requires treatment with antibiotics. Oral antibiotics are typically effective. More challenging cases may require hospitalization and antibiotics that are delivered intravenously.
Heel (Retrocalcaneal) Bursitis Surgery
Particularly challenging cases of retrocalcaneal bursitis may be treated with surgery to remove the troublesome bursa. This surgery, called a bursectomy, is rarely needed.
After surgery, a new retrocalcaneal bursa may develop. The hope is that the new bursa is less prone to inflammation.
Surgery can be effective, but operating on this bony area presents challenges. Potential risks include slow healing, infection, damage to the Achilles tendon, and continued heel pain. 6 Wiegerinck JI, Kok AC, van Dijk CN. Surgical treatment of chronic retrocalcaneal bursitis. Arthroscopy. 2012 Feb;28(2):283-93. PMID: 22244103. DOI: 10.1016/j.arthro.2011.09.019
Other surgical procedures
A bursectomy may be performed along with other surgical procedures. For example, a surgeon may remove a sliver of bone from the back of the heel (Haglund deformity) to alter foot mechanics and reduce future friction. Bone spurs may also be removed.
No matter what type of treatment is used, it is important to wait until all pain and swelling around the back of the heel is gone before resuming activities. This may take several weeks.
A cautious, gradual return to normal activities is encouraged. Returning to activities too soon can cause heel bursitis symptoms to flare up again.