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

Calcaneal Bursitis: Follow-up

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

Follow-up

Further Outpatient Care

  • The patient should return for re-evaluation every 4-6 weeks until the symptoms are resolved or under adequate control.
  • These follow-up visits provide the clinician with an opportunity to monitor the efficacy of the treatment plan and to make appropriate modifications if the patient's symptoms have not adequately improved.

Deterrence

  • The patient should avoid footwear that fits tightly at the posterior heel.
  • High-heeled shoes should be avoided.

Complications

  • Chronic or progressive posterior heel pain
  • Limping (antalgic gait)
  • Achilles tendon rupture occurring secondary to chronic inflammation or perhaps resulting from corticosteroid injection

Prognosis

  • Most patients respond well to a combination of local icing, oral anti-inflammatory medications, Achilles tendon stretching, and footwear modification.
  • Surgical intervention may provide good results for patients in whom conservative treatment has failed.

Patient Education

  • The patient should be educated in the proper performance of Achilles tendon stretching.
  • The patient should understand the rationale for appropriate footwear.
  • A patient who is considering corticosteroid injection must understand the potential risks and benefits of this treatment.
  • For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center. Also, see eMedicine's patient education article Bursitis.

Miscellaneous

Medicolegal Pitfalls

  • Because with a local corticosteroid injection at the posterior ankle the potential exists for an increased risk of Achilles tendon rupture, such injections should generally be avoided or the patient should be informed of the potential risk during the informed consent process.
  • Calcaneal stress fracture should be considered, particularly if there is bony tenderness at the midcalcaneal region (rather than at the Achilles tendon and its associated bursae). Since plain radiographs alone may miss a stress fracture, further imaging, such as a 3-phase bone scan or a CT scan, should be considered.

Special Concerns

  • Athletes are often eager to continue or resume their usual exercise programs in a manner that is too rapid to allow for adequate physiologic recovery. Thus, offering the athlete alternative means of maintaining strength and cardiovascular fitness (eg, swimming, pool aerobics) is important.
 
Acknowledgments

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the revision of this manuscript.



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

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

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  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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