Many cases of retrocalcaneal and retroachilles bursitis can be treated effectively at home. If home treatments fail to work, a doctor can prescribe one or more treatments (described below).
People treating heel bursitis at home are advised to:
Wear comfortable, supportive shoes. People can minimize friction at the heel by avoiding shoes that press against the back of the heel and wearing comfortable, supportive footwear. Shoes with an "Achilles notch," a groove in the collar at the back of the shoe to protect the Achilles tendon, can be particularly helpful. (Almost all running shoes are designed with an Achilles notch.)
Rest. Frequent resting of the foot is essential for inflammation reduction. Medical professionals typically recommend the R.I.C.E. formula, which includes Rest, Ice, Compression, and Elevation.
Over-the-counter NSAIDs, such as ibuprofen and naproxen, can also help relieve heel pain and inflammation associated with retrocalcaneal bursitis.
When heel bursitis does not resolve with home treatment, or if symptoms indicate septic bursitis, consultation with a doctor is advised. A doctor can evaluate the patient for other potential problems and/or recommend one or more of the treatments described below.
Orthotics. Wearing an orthotic device such as a heel insert can encourage better mechanics in the foot and reduce irritation of the retrocalcaneal bursa. (Many people do not need special orthotics but simply need to stop wearing shoes with rigid heel and ankle construction and instead wear more supportive, comfortable shoes.)
Stretching and physical therapy. Stretching the Achilles tendon often helps alleviate pain. Once the pain is resolved it is important for the patient to continue a regular stretching program. Regular stretching reduces the chance of recurrence.
Topical medications. Less commonly used than oral medications, topical NSAID and lidocaine patches are sometimes prescribed, particularly for patients who want to minimize gastrointestinal side effects. Topical medications are growing more popular, though their ability to treat bursitis has not been well researched.
Aspiration. An aspiration to remove fluid from the swollen bursa with a needle and syringe can often relieve pressure.
Corticosteroid injections. Although not used in every case, symptoms may be quickly relieved with corticosteroid injections. While effective, some studies have shown these injections have been associated with a degeneration of the Achilles tendon, so stretching and running should be avoided after an injection to prevent tendon injury.1-5 Often, as a precaution, a short period of immobilization following an injection is performed to protect the Achilles attachment.
Ultrasound. Using sound waves, ultrasound causes a vibration through the skin that may stimulate blood flow and healing. Patients do not feel discomfort during this procedure, which typically takes place in a physical therapist’s office.
Antibiotics. Only septic bursitis requires treatment with antibiotics. The choice of antibiotic may be influenced by what microorganism is causing the infection. Most people with septic bursitis are effectively treated with oral antibiotics. More challenging cases may require hospitalization and antibiotics delivered intravenously.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site.
In addition to removing the bursa, a doctor may use the surgery to treat another condition associated with retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any bone spurs located where the Achilles attaches to the heel may also be removed.
Regardless of the conservative treatment that is provided, 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. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis symptoms began.
Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.