There are 2 main bursas in the Achilles region. The retrocalcaneal bursa and the Achilles bursa.
The Retrocalcaneal bursa sits between the calcaneum and where the Achilles inserts into the heel.
The Achilles bursa lies between where the Achilles inserts to the heel and the skin.
Basically a bursa is a small fluid sac. The role of a bursa is to prevent friction of a tendon on bone. Irritation of a bursa is termed ‘bursitis’.
Signs & Symptoms
What Causes It?
Aggravating factors can include friction from stiff or ill-fitting shoes, or high heel tabs at the back of shoes. Other contributing factors can include overuse of the underlying tendon, muscle tightness or imbalance and the presence of a structural bony prominence close to the bursa.
How to Self Manage
Self management should include rest, ice, and NSAIDs if not contraindicated. Stretching the calf and Achilles can help reduce friction if the muscles are excessively tight.
If conservative management fails to reduce the pain, then other options include aspiration of the bursa, or alternately a corticosteroid injection.
Ultrasound and MRI can be useful to assess the condition of the tendon and bursa. X-ray may also be used to see if there is a bony growth or calcification of the tendon. Bony growth on the posterolateral part of the calcaneum is referred to as Haglund’s deformity.
Typically pathology of the Achilles tendon where it inserts tends to take longer than if the problem is higher up in the mid portion of the tendon. Surgery to remove a problematic bony growth is an option if conservative management proves unsuccessful.
How Physio Helps
A physiotherapist will aim to identify the structures and mechanisms which are irritating the bursa. They will assess your biomechanics, and examine the joints surrounding musculature. Manual treatment may include joint mobilisation, soft tissue release, exercise prescription, advice regarding heel raises, aswell as the use of acupuncture or electrical physical agents.