Pain Behind The Heel: Retrocalcaneal Bursitis

By Dr. Amod Manocha, International Pain Centre

Are you experiencing pain at the back of your heel, especially when walking, running, or rising onto your toes? If so, you might be dealing with a common but often misunderstood condition known as retrocalcaneal bursitis.

In this blog, I’ll explain what retrocalcaneal bursitis is, why it happens, its symptoms, and how it can be treated effectively.

What Is Retrocalcaneal Bursitis?

Let’s break it down:

• Retro = behind
• Calcaneal = related to the heel bone (calcaneus)
• Bursitis = inflammation of a bursa (a small fluid-filled sac that reduces friction)

Retrocalcaneal bursitis refers to inflammation of the bursa located between the heel bone and the tendon at the back of ankle called the Achilles tendon. This bursa acts as a cushion, helping smooth movement at the back of the ankle. When it becomes irritated or inflamed, it leads to pain and swelling.

This is the most common type of heel bursitis and is often confused with a problem in the Achilles tendon called the Achilles tendinopathy.

Causes of Retrocalcaneal Bursitis

Retrocalcaneal bursitis can affect both active individuals and those with sedentary lifestyles. Common causes include:

• Overuse or repetitive strain – such as frequent running, jumping, or walking uphill
• Wearing tight or poorly fitting shoes that rub the back of the heel
• Sudden increase in physical activity
• Lack of stretching before workouts or intense activity
• Switching from high heels to flat shoes, putting unexpected strain on the Achilles tendon
• Foot or ankle trauma, such as a fall or impact
• Medical conditions like rheumatoid arthritis, gout, or other inflammatory joint diseases
• Haglund’s deformity – a bony prominence at the back of the heel that can irritate the bursa

Who’s at Risk?

Athletes, dancers, runners, yoga lovers… and yes, even non-athletes who wear high heels or flat shoes suddenly! You may be more likely to develop retrocalcaneal bursitis if you:

• Are over 65 years of age
• Play high-impact sports (like running, tennis, or football)
• Have a job that involves repetitive ankle movements
• Don’t stretch or warm up properly before exercise
• Have tight calf muscles
• Wear shoes that compress the back of your heel
• Wear high heels for prolonged periods and switch to flats suddenly
• Have autoimmune conditions like rheumatoid arthritis, gout, or ankylosing spondylitis

Common Symptoms of Retrocalcaneal Bursitis

The hallmark sign of retrocalcaneal bursitis is pain at the back of the heel, especially when:

• Walking or running uphill
• Rising on your toes (e.g., standing tip-toe)
• Wearing shoes that press on the heel
• Flexing your foot

Other symptoms include:

• Swelling and tenderness at the back of the heel
• Redness or warmth over the affected area
• Pain in the calf or stiffness in the ankle
• A crackling or creaking sound when moving the ankle
• Stiffness or reduced range of motion in the ankle

Symptoms can worsen with increased physical activity or tight footwear and improve with rest.

How Is Retrocalcaneal Bursitis Diagnosed?

At the International Pain Centre, diagnosis begins with a detailed history and clinical examination. If required, the following tests may be used to confirm the diagnosis or rule out other conditions:

• X-ray: To detect bone spurs or deformities (like Haglund’s deformity)
• Ultrasound: To view bursa swelling and rule out Achilles tendon injuries
• MRI: if symptoms are persistent or diagnosis is unclear
• Fluid aspiration: Rarely done, but may be considered if infection is suspected

Treatment Options for Retrocalcaneal Bursitis

Most people recover well with non-surgical treatments. The goal is to reduce inflammation, protect the bursa, and prevent further irritation.

Conservative Treatment Options:

• Rest & Activity Modification- Avoid activities that aggravate your pain, such as running or jumping and switch to low-impact exercises such as swimming or cycling.
• Ice Therapy- Apply an ice pack to the back of the heel for 15–20 minutes, several times daily, especially during flare-ups.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling.
• Footwear Changes – Avoid tight shoes that rub against the heel. Choose shoes with a soft heel counter or open backs (like clogs) and use cushioned heel inserts or pads.
• Physical Therapy & Stretching- Gentle stretching and strengthening exercises for the calf and ankle improve flexibility and reduce pressure on the bursa. Avoid aggressive calf stretches during acute pain as this can worsen symptoms.
• Ultrasound-Guided Corticosteroid Injections – In severe or persistent cases, an ultrasound guided corticosteroid injection may be considered to reduce inflammation. This is generally helpful in reducing/ controlling symptoms.

When Is Surgery Considered?

Surgery is rarely needed. However, if conservative treatments fail and symptoms are disabling, a bursectomy (removal of the inflamed bursa) may be considered, sometimes combined with treatment for any bone abnormalities such as Haglund’s deformity.

Can Retrocalcaneal Bursitis Be Prevented?

While not all cases can be prevented! Here are simple steps to reduce your risk:

• Warm up and stretch properly before physical activities
• Avoid sudden increases in activity & training intensity
• Choose supportive, well-fitting footwear
• Maintain good posture and body mechanics during sports and daily activities
• Listen to your body—if your heels hurt, don’t ignore it

Final Thoughts

Retrocalcaneal bursitis is a painful but treatable condition. Early recognition, proper footwear, and conservative management can help you get back to your normal activities without long-term problems. If you’re struggling with persistent heel pain or suspect you may have bursitis, don’t delay and seek specialist help. At the International Pain Centre, we offer advanced diagnostic tools and personalised treatment plans to help you get lasting relief.

Written by Dr. Amod Manocha
Consultant in Pain Medicine
International Pain Centre – Excellence in Pain Management