eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Calcaneal Bursitis: Differential Diagnoses & Workup

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
Contributor Information and Disclosures

Updated: May 4, 2008

Differential Diagnoses

Achilles Tendon Injuries and Tendonitis
Plantar Fasciitis
Rheumatoid Arthritis
Stress Fracture

Other Problems to Be Considered

Gout
Haglund deformity
Seronegative spondyloarthropathies
Stress fracture of the calcaneus
Sural neuritis

Workup

Laboratory Studies

  • If the appearance of the bursitis cannot be explained by local factors (eg, ill-fitting shoes, excessive running, high heels) or if there are systemic symptoms or signs of rheumatologic involvement, the clinician should consider laboratory studies to evaluate for the possibility of gout (hyperuricemia), rheumatoid arthritis (rheumatoid factor), and seronegative spondyloarthropathies (HLA B-27, erythrocyte sedimentation rate, and/or C-reactive protein).

Related Medscape topics:
Resource Center Gout
Resource Center Rheumatoid Arthritis

Imaging Studies

  • Plain radiographs of the calcaneus may reveal Haglund deformity, which can be seen best on the lateral view.
  • Plain radiographs can also be used to evaluate for stress fracture of the calcaneus. If the plain radiographs are negative for stress fracture but this injury possibility remains a significant diagnostic consideration, a 3-phase bone scan or a computed tomography (CT) scan of the calcaneus should be obtained.
  • Magnetic resonance imaging (MRI) scans may demonstrate bursal inflammation but probably do not offer much more information than is apparent from careful physical examination. Theoretically, MRI scans may help to determine whether the inflammation is in the subcutaneous calcaneal bursa, the subtendinous calcaneal bursa, or the tendon itself, but such testing is generally unnecessary.8,9
  • Some clinicians have suggested that ultrasonography can be used in place of MRI in cases in which imaging is desired to investigate pathology at the posterior heel, but further research in this area is needed.10,11

Procedures

  • Generally, no diagnostic procedures are required.

Histologic Findings

Bursal inflammation is present in patients with calcaneal bursitis, but obtaining a histologic specimen from an actual patient would be extremely rare.

More on Calcaneal Bursitis

Overview: Calcaneal Bursitis
Differential Diagnoses & Workup: Calcaneal Bursitis
Treatment & Medication: Calcaneal Bursitis
Follow-up: Calcaneal Bursitis
Multimedia: Calcaneal Bursitis
References
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References

  1. Brinker MR, Miller MD. The adult foot. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:342-63.

  2. Foot and ankle. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:366-489.

  3. McGee DJ. Lower leg, ankle, and foot. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:448-515.

  4. Kachlik D, Baca V, Cepelik M, et al. Clinical anatomy of the retrocalcaneal bursa. Surg Radiol Anat. Mar 11 2008;[Medline].

  5. Teebagy AK. Leg and ankle. In: Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:241-67.

  6. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:783-812.

  7. Aldridge T. Diagnosing heel pain in adults. Am Fam Physician. Jul 15 2004;70(2):332-8. [Medline]. [Full Text].

  8. Eshed I, Althoff CE, Feist E, et al. Magnetic resonance imaging of hindfoot involvement in patients with spondyloarthritides: comparison of low-field and high-field strength units. Eur J Radiol. Jan 2008;65(1):140-7. [Medline].

  9. Erdem CZ, Tekin NS, Sarikaya S, et al. MR imaging features of foot involvement in patients with psoriasis. Eur J Radiol. Nov 8 2007;[Medline].

  10. Reiter M, Ulreich N, Dirisamer A, et al. [Extended field-of-view sonography in Achilles tendon disease: a comparison with MR imaging]. Rofo. May 2004;176(5):704-8. [Medline].

  11. Sofka CM, Adler RS, Positano R, et al. Haglund's syndrome: diagnosis and treatment using sonography. HSS J. Feb 2006;2(1):27-9.

  12. Olsen NK, Press JM, Young JL. Bursal injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.

  13. Ortmann FW, McBryde AM. Endoscopic bony and soft-tissue decompression of the retrocalcaneal space for the treatment of Haglund deformity and retrocalcaneal bursitis. Foot Ankle Int. Feb 2007;28(2):149-53. [Medline].

  14. Nonsteroidal anti-inflammatory drugs (NSAIDs). In: Green SM, ed. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000:11-2.

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Further Reading

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Keywords

calcaneal bursitis, bursitis of the subtendinous or subcutaneous bursa of the calcaneal (Achilles) tendon, bursitis of the subtendinous or subcutaneous calcaneal bursa, bursitis of the subtendinous or subcutaneous retrocalcaneal bursa, exostosis, Haglund deformity, prominence of the posterior superior calcaneus, retrocalcaneal bursitis, pump bump

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Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Daniel D Scott, MD, MA, BS, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center
Daniel D Scott, MD, MA, BS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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