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Retrocalcaneal Bursitis

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Other Names

  • Subcutaneus Calcaneal Bursitis
  • Albert disease
  • Calcaneus altus
  • Pump bump
  • Winter heel
  • Achillodynia
  • Chronic retrocalcaneal bursitis
  • Subtendinous Bursitis

Background

History

  • First described by Painter in 1898[1]

Epidemiology

  • The epidemiology of retroachilles bursitis is poorly described in the literature

Pathophysiology

Illustration of the retrocalcaneal bursa[2]
  • General
    • Overuse injury commonly seen in middle aged or older athletes
    • Inflammation of the bursa leads to heel and ankle pain, limiting function
    • Characterized by pain anterior to the Achilles tendon and superior to the calcaneus
  • Etiology
    • Repetitive impingement of the bursa between the anterior aspect of the Achilles tendon and a bony posterosuperior calcaneal prominence

Associated Conditions

Pathoanatomy


Risk Factors


Differential Diagnosis


Clinical Features

  • History
    • Patients typically report posterior heel pain
    • Swelling may or may not be present
    • Typically worse during early exercise and improves during the workout
  • Physical Exam: Physical Exam Ankle
    • Swelling at the bursa may be noted (i.e. 'pump bump')
    • Passive dorsiflexion often induces pain
    • Active plantarflexion reproduces pain
  • Special Tests
    • Two Finger Squeeze Test: Pressure is applied with the fingers placed medially and laterally anterior to the Achilles tendon insertion

Evaluation

Ankle XR showing the retrocalcaneal recess has disappeared because of the less radiolucent fluid in the distended retrocalcaneal bursa[6]

Radiographs

Ultrasound

  • Best performed with the patient laying prone
    • Allows easy evaluation, comparison of both ankles
  • Findings
    • Triangular hypoechoic lesion situated between the Achilles tendon and the calcaneus

MRI

  • Not required to make diagnosis
  • Bursa will appear as an enlarged, fluid-filled structure
    • Low signal intensity on T1-weighted images
    • High signal intensity on fluid-sensitive images

Classification

  • Not applicable

Management

Nonoperative

  • Indications
    • Virtually all cases
  • Ice Therapy
  • Activity modification
  • NSAIDS
  • Heel Cup
    • Raises the heel, offloading the bursa and achilles tendon
  • Physical Therapy
    • Emphasis on stretching the Achilles tendon
  • Footwear modification
    • Shoes that are open backed may relieve pressure or tension
  • Microcurrent therapy
    • One study suggested this was helpful as an adjunct when combined with standard therapy[7]
  • Corticosteroid Injection
    • Performed under ultrasound or fluoroscopic guidance
    • There is likely some risk to the Achilles Tendon, although this is not clearly established[8][9]
    • Under fluoroscopy, patients reported a 50% reduction in pain[10]

Operative

  • Indications
    • Refractory to conservative management
  • Technique
    • Bursectomy

Rehab and Return to Play

Rehabilitation

  • Stretching posterior chain and Achilles tendon likely to help

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Unknown

Complications

  • Chronic pain
  • Inability to return to sport
  • Trouble running

See Also


References

  1. Painter CF. Inflammation of the post-calcaneal bursa associated with exostosis. J Bone Joint Surg Am 1898;s1-11:169-180.
  2. Chu NK, Lew HL, Chen CP. Ultrasound-guided injection treatment of retrocalcaneal bursitis. Am J Phys Med Rehabil. 2012 Jul. 91(7):635-7.
  3. Theobald P, Bydder G, Dent C, et al.: The functional anatomy of Kager’s fat pad in relation to retrocalcaneal problems and other hindfoot disorders. J Anat 2006; 208: 91–7
  4. Wnuk-Scardaccione, Agnieszka, et al. "Surface Shape of the Calcaneal Tuberosity and the Occurrence of Retrocalcaneal Bursitis among Runners." International Journal of Environmental Research and Public Health 18.6 (2021): 2860.
  5. Campanelli, Valentina, et al. "Lower extremity overuse conditions affecting figure skaters during daily training." Orthopaedic journal of sports medicine 3.7 (2015): 2325967115596517.
  6. Van Sterkenburg MN, Muller B, Maas M, Sierevelt IN, van Dijk CN. Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis. Acta Orthop. 2010 Jun. 81(3):387-90.
  7. Aliyev, R., Q. Muslimov, and G. Geiger. "Results of conservative treatment of achillodynia with application micro-current therapy." Georgian Med. News. Oct 187 (2010): 35-42.
  8. Pękala, P. A., et al. "The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study." Bone & joint research 6.7 (2017): 446-451.
  9. Turmo-Garuz, A., et al. "Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?." Musculoskeletal surgery 98.2 (2014): 121-126.
  10. Goldberg-Stein, Shlomit, et al. "Fluoroscopically guided retrocalcaneal bursa steroid injection: description of the technique and pilot study of short-term patient outcomes." Skeletal radiology 45.8 (2016): 1107-1112.
Created by:
John Kiel on 26 June 2019 19:42:55
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Last edited:
3 October 2022 23:53:28
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