Retrocalcaneal Bursitis
Introduction[edit | edit source]
Bursitis is the inflammation of a bursa. Retrocalcaneal bursitis is in inflammation of the bursa located between the calcaneus and the anterior surface of the Achilles tendon[1].There are two bursae located just superior to the insertion of the Achilles (calcaneal) tendon.[2]
- Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the Achilles tendon and the calcaneus[3].
- 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.[4][5][6]
It is also known as Achille tendon bursitis. It can often be mistaken for Achilles tendonitis or can also occur in conjunction with Achilles tendonitis.
Clinical Anatomy and pathogenesis
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The Achilles tendon insertion, the fibrocartilagios walls of the retrocalcaneal burse that extends into the tendon and the adjacent calcaneum form an "ENTHESIS ORGAN". The key concept is that at this site the tendon insertion, the bursa and the bone are so intimately related that a prominence of the calcaneum will greatly predispose to mechanical irritation of the bursa and the tendon. Also, ther is significant strain on the tendon insertion on the posterior aspect of the tendon with dorsiflexion.[7][8]
Epidemiology[edit | edit source]
Its fairly comman in normal population as campared to athlets in whom this is quiet comman. In normal population its incidence is high in individuals who are accustomed to wearing high-heeled shoes on a long-term basis may experience increased stretch and irritation of the Achilles tendon and its associated bursae when switching to flat shoes.
Causes
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- Overtraining in an athlete
- Tight or poorly fitting shoes that produce excessive pressure at the posterior heel
- Haglund deformity
- Altered joint axis
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.[3]
Sign and Symptoms[edit | edit source]
- Pain at the back of the heel, especially when running uphill.
- Pain may get worse when rising on the toes (standing on tiptoes)
- Tenderness at the back of heel
- Swelling at the back of heel.
Treatment[edit | edit source]
Resources[edit | edit source]
References[edit | edit source]
- ↑ Fauci, Anthony (2010). Harrison's Rheumatology, Second Edition. McGraw-Hill Professional Publishing; Digital Edition. p. 271
- ↑ Brinker MR, Miller MD. The adult foot. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders Co; 1999:342-63.
- ↑ 3.0 3.1 Cite error: Invalid
<ref>tag; no text was provided for refs namedbrinker - ↑ McGee DJ. Lower leg, ankle, and foot. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1992:448-515.
- ↑ Snider RK, ed. Foot and ankle. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy of Orthopedic Surgeons; 1997:366-489.
- ↑ Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996:783-812.
- ↑ Lyman J, Weinhold PS, Almekinders LC. Strain behaviour of the distal Achilles tendon: Implications for insertional Achilles tendinopathy. Am J Sports Med 2004; 32(2):457-61.
- ↑ Brukner P, Khan K. Clinical Sports Medicine. Chapter 32; 3rd Edition.
