Retrocalcaneal Bursitis

Updated: Sep 12, 2019
  • Author: Patrick M Foye, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Practice Essentials

Pain at the posterior heel or ankle is most commonly caused by pathology at either the posterior calcaneus (at the calcaneal insertion site of the Achilles tendon) or at its associated bursae. Two bursae are located just superior to the insertion of the Achilles (calcaneal) tendon. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the Achilles tendon and the calcaneus. Posterior or superficial to the Achilles tendon is the subcutaneous calcaneal bursa, also called the Achilles bursa. This bursa is located between the skin and posterior aspect of the distal Achilles tendon. Inflammation of either or both of these bursa can cause pain at the posterior heel and ankle region. [1, 2, 3, 4, 5]

Patients with insertional Achilles tendinopathy often have thickened subcutaneous and retrocalcaneal bursae with higher blood flow in the bursa walls. These patients may also have Haglund deformities. [6]

For patient education resources, see the Foot, Ankle, Knee, and Hip Center, as well as Bursitis and Tendinitis.

See related Medscape Reference topics Achilles Tendon Injuries and TendonitisAchilles Tendonitis, and Bursitis.




United States

Retrocalcaneal bursitis is fairly common.


Sport-Specific Biomechanics

Inflammation of the calcaneal bursae is most commonly caused by repetitive (cumulative) trauma or overuse, and the condition is aggravated by pressure, such as when athletes wear tight-fitting shoes. Retrocalcaneal bursitis may also be associated with conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies. In some cases, retrocalcaneal bursitis may be caused by bursal impingement between the Achilles tendon and an excessively prominent posterosuperior aspect of the calcaneus (Haglund deformity). In Haglund disease, impingement occurs during ankle dorsiflexion. [1, 2, 3, 4, 5]