What is Retrocalcaneal Bursitis - Sports Therapy Edinburgh
Retrocalcaneal bursitis is a common cause of pain at the back of the heel. It develops when the small fluid-filled sac (bursa) located between the Achilles tendon and heel bone becomes irritated and inflamed. Normally, the bursa allows the Achilles tendon to glide smoothly during walking, running and other daily activities.
Because the symptoms closely resemble Achilles tendinopathy, retrocalcaneal bursitis is frequently overlooked, despite the two conditions often occurring together. If the inflamed bursa isn't recognised, it can continue to cause compression and irritation around the Achilles tendon, slowing recovery and making rehabilitation less effective.
Typical symptoms include pain and tenderness at the back of the heel, swelling, stiffness after periods of rest and a sharp pain when the sides of the heel are squeezed. Many people also describe a burning, aching or pinching sensation, particularly when walking uphill, climbing stairs, running or wearing shoes that press against the back of the heel.
Treatment focuses on settling the inflammation, reducing compression around the bursa and gradually restoring the strength and capacity of the Achilles tendon. With the right diagnosis and a structured rehabilitation programme, most people recover well and return to everyday activities, exercise and sport.
Because the symptoms closely resemble Achilles tendinopathy, retrocalcaneal bursitis is frequently overlooked, despite the two conditions often occurring together. If the inflamed bursa isn't recognised, it can continue to cause compression and irritation around the Achilles tendon, slowing recovery and making rehabilitation less effective.
Typical symptoms include pain and tenderness at the back of the heel, swelling, stiffness after periods of rest and a sharp pain when the sides of the heel are squeezed. Many people also describe a burning, aching or pinching sensation, particularly when walking uphill, climbing stairs, running or wearing shoes that press against the back of the heel.
Treatment focuses on settling the inflammation, reducing compression around the bursa and gradually restoring the strength and capacity of the Achilles tendon. With the right diagnosis and a structured rehabilitation programme, most people recover well and return to everyday activities, exercise and sport.
Why Accurate Assessment Matters
Compared with many other foot and ankle conditions, relatively little research has focused specifically on the conservative management of retrocalcaneal bursitis. Much of the available literature centres on imaging or surgical treatment rather than rehabilitation. Researchers, including C. Niek van Dijk, have highlighted that retrocalcaneal bursitis commonly co-exists with Achilles tendon disorders, making it difficult to distinguish without a thorough clinical assessment.
At Sports Therapy Edinburgh, we assess the entire posterior heel rather than focusing solely on the Achilles tendon. By identifying whether the bursa, the tendon or both structures are contributing to your pain, we can direct treatment towards the true source of your symptoms and reduce the risk of prolonged recovery.
At Sports Therapy Edinburgh, we assess the entire posterior heel rather than focusing solely on the Achilles tendon. By identifying whether the bursa, the tendon or both structures are contributing to your pain, we can direct treatment towards the true source of your symptoms and reduce the risk of prolonged recovery.
Treatment at Sports Therapy Edinburgh
If you're struggling with retrocalcaneal bursitis, early diagnosis and the right treatment can make a significant difference to your recovery. Every assessment at Sports Therapy Edinburgh is designed to identify the underlying cause of your heel pain before creating a rehabilitation programme tailored to your goals.
Treatment may include:
Treatment may include:
- Comprehensive assessment to identify whether the pain is coming from the retrocalcaneal bursa, Achilles tendon or both, while assessing ankle mobility, calf strength, loading capacity, footwear and movement patterns.
- Activity modification to reduce irritation and allow the inflamed bursa to settle without unnecessarily avoiding movement.
- Footwear advice and heel lifts, where appropriate, to reduce compression at the back of the heel.
- Hands-on treatment to improve ankle mobility and address stiffness around the foot and ankle.
- Progressive strengthening of the calf muscles and Achilles tendon to restore strength, improve load tolerance and reduce the risk of recurrence.
- Graduated return to activity, helping you safely return to walking, running and sport as your symptoms improve.
- Specialist referral, if symptoms persist despite comprehensive rehabilitation, to discuss options such as image-guided injections or surgical management.
References & further reading:
- De Vos, R.-J., van der Vlist, A. C., Zwerver, J., Meuffels, D. E., Smithuis, F., van Ingen, R., van der Giesen, F., Visser, E., Balemans, A., Pols, M., Veen, N., den Ouden, M., & Weir, A. (2021). Dutch multidisciplinary guideline on Achilles tendinopathy. British Journal of Sports Medicine, 55 (20), 1125–1134.
Link: https://doi.org/10.1136/bjsports-2020-103867 - Lohrer, H., & Nauck, T. (2014). Retrocalcaneal bursitis but not Achilles tendinopathy is characterized by increased pressure in the retrocalcaneal bursa. Clinical Biomechanics, 29 (3), 283–288.
Link: https://doi.org/10.1016/j.clinbiomech.2013.12.002 - van Dijk, C. N., van Sterkenburg, M. N., Wiegerinck, J. I., Karlsson, J., & Maffulli, N. (2011). Terminology for Achilles tendon related disorders. Knee Surgery, Sports Traumatology, Arthroscopy, 19 (5), 835–841.
Link: https://doi.org/10.1007/s00167-010-1374-z
