eMedicine Specialties > Sports Medicine > Foot and Ankle

Retrocalcaneal 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 (www.TailboneDoctor.com), 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; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine; Scott F Nadler, DO, Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital
Contributor Information and Disclosures

Updated: Mar 5, 2009

Follow-up

Return to Play

Athletes with retrocalcaneal bursitits may be expected to return to play without restrictions after they demonstrate the following:

  • Resolution of symptoms
  • Resolution of previous physical examination findings (eg, limping, tenderness on palpation)
  • Adequate performance of sports-specific practice drills without recurrence of symptoms or physical examination findings

Complications

  • The posterior heel pain may become chronic or progressive, resulting in limping (antalgic gait) and decreased athletic performance.
  • Achilles tendon rupture may occur secondary to chronic inflammation and/or due to corticosteroid injection.

Prevention

Patients with retrocalcaneal bursitis should consider the following preventive measures:

  • Wear properly fitting footwear, and change running shoes on a regular basis, depending on the amount of use.
  • Avoid footwear that fits too tightly at the posterior heel.
  • Avoid high-heeled shoes.
  • Avoid corticosteroid injection by other clinicians, unless the risk of Achilles tendon rupture is fully understood.

Prognosis

  • Most patients with retrocalcaneal bursitis respond well to a combination of local icing, oral medications, Achilles stretching, and modification of footwear.
  • In general, patients with persistent symptoms despite nonsurgical measures (see Acute Phase Physical Therapy and Other Treatment) can expect improvement with any of the previously discussed surgical interventions (see Surgical Interventions).

Education

Patients should be thoroughly educated and informed about the following:

  • The proper performance of Achilles tendon stretching
  • The rationale for donning appropriate footwear
  • The potential risks and benefits of corticosteroid injection for those who are considering receiving this treatment 
  • The risks, benefits, and expected outcomes of surgical intervention for those in whom conservative therapy has failed

Miscellaneous

Medicolegal Pitfalls

  • In general, corticosteroid injection should be avoided due to the increased risk of Achilles tendon rupture with local injection at the posterior ankle.
  • Failure to diagnose a calcaneal stress fracture can occur, particularly if bony tenderness is present at the mid calcaneal region rather than the more common location at the Achilles tendon and its associated bursae.
  • Stress fractures may remain undiagnosed due to failure to consider further imaging, such as 3-phase bone scanning or CT scanning when plain radiographs appear normal.

Special Concerns

  • Athletes are often very eager to continue or resume their usual exercise programs, sometimes too rapidly to allow for adequate physiologic and/or physical recovery.
  • Alternative means of maintaining strength and cardiovascular fitness should be discussed with the patient, including water exercises such as swimming and pool aerobics.
 
Acknowledgments

Greg Gazzillo, 4th year medical student, New Jersey Medical School–UMDNJ, Class of 2007, assisted with the 2006 revision of this manuscript.

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the 2007 revision of this manuscript.

Evish Kamrava, 4th year medical student, St. George's University School of Medicine, Class of 2009, assisted with the 2008 revision of this manuscript.



More on Retrocalcaneal Bursitis

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

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Further Reading

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Keywords

retrocalcaneal bursitis, calcaneal bursitis, pump bump (exostosis), bursitis of the subtendinous or subcutaneous retrocalcaneal bursa, bursitis of the subtendinous or subcutaneous calcaneal bursa, bursitis of the subtendinous or subcutaneous bursa of the calcaneal (Achilles) tendon, Haglund deformity, adhesive capsulitis

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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 (www.TailboneDoctor.com), 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; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
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.

Scott F Nadler, DO, Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital
Scott F Nadler, DO is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

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