Inflammation of the bursa at the attachment of the Achilles to the heel bone

Foot, Achilles

INFLAMMATION OF THE BURSA AT THE ATTACHMENT OF THE ACHILLES TO THE HEEL BONE

Diagnosis: INFLAMMATION OF THE BURSA AT THE ATTACHMENT OF THE ACHILLES
TO THE HEEL BONE
(BURSITIS ACHILLES)


Anatomy: The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The Achilles is attached to the heel bone (calcaneus). At the heel bone there is a bursa in front of the Achilles anchor point (bursae tendinis Achilles), as well as behind (bursae subcutanea calcanei). The bursa reduce the pressure against the heel bone.
Cause: Inflammation of the bursa in front of and behind the Achilles occurs with continued overload, where the bursa is squeezed against the heel bone (for example an ill-fitting heel cap on the shoe).

Symptoms: Pain when activating the Achilles tendon (running and jumping) and when applying pressure at the point of attachment of the tendon on the heel bone. Contrary to the tenderness occurring with inflammation of the Achilles tendon, the tenderness is localised to the point of attachment to the heel bone.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required in light cases where the tenderness is minimal. In all cases where smooth improvement is not experienced, medical attention should be sought as soon as possible to exclude a (partial) rupture of the Achilles tendon or rupture of the soleus muscle. This situation is best determined by use of ultrasound scanning, as a number of injuries requiring treatment can easily be overlooked during a clinical examination (Ultrasonic image). Ultrasound scanning enables an evaluation of the extent of the change in the tendon; inflammation of the tendon (tendinitis), development of cicatricial tissue (tendinosis), calcification, inflammation of the tissue surrounding the tendon (peritendinitis), inflammation of the bursa (bursitis), as well as (partial) rupture (article).

Treatment: Treatment is primarily comprised of relief from the painful activity (running). It is important that shoes do not pinch the heel. If satisfactory progress is not made during the rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the bursa. Injections should be performed under ultrasound guidance to ensure optimal effect and reduce the risk of injecting into the Achilles itself. If progress is not made neither through rehabilitation nor medicinal treatment, surgical treatment can be attempted (article-1), (article-2).

Bandage: In some cases a ring of felt (for example) can be taped around the tender bursa which will reduce the pressure from shoes. It is naturally important that the hole in the ring is positioned directly above the bursa.

Complications: If there is not a steady improvement in the condition an ultrasound scan should be performed to exclude: