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Chief complaint: “Posterior heel pain”
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Retrocalcaneal bursitis
The retrocalcaneal bursa is located between the Achilles tendon and the posterior superior border of the calcaneus.
H&P: Inflammation and pain may follow repetitive dorsi/plantar flexion of the ankle (excessive running, jumping activities). Tenderness anterior and superior to the Achilles insertion on the heel.
Treatment: Minimize weight bearing. ½ inch elevation. NSAIDs.
Posterior calcaneal bursitis
This bursa is subcutaneous, just superficial to the insertion of the Achilles tendon.
H&P: Inflammation and pain may follow irritation from the upper border of the heel counter of a shoe. Posterior heel pain. Tender “bump” (the inflamed and swollen bursa) on the back of the heel.
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Treatment: Opened-heeled shoes, sandals, or placement of a “U-shaped” pad between the heel and the counter. NSAIDs. Advance to shoes with soft or less convex heel counters.