The most common bursae to be inflamed in the ankle area is the retrocalcalneal bursae which is located between the Achilles tendon and the calcaneus (heel bone). The bursae acts as a cushion to protect the Achilles tendon from friction against the heel bone.  Bursitis occurs when a bursa is irritated from frequent pressure and it becomes inflamed.  

Bursitis in the back of the heel is usually associated with prolonged walking, wearing poorly designed shoes or high heels or in athletes who overuse the back of the foot, such as ballerinas or runners. Anything that may cause trauma in the Achilles area, such as shoe straps rubbing on the heel, can cause the retrocalcaneal bursae to become inflamed. This type of bursitis often occurs with Achilles tendonitis but can occur on its own as well.

If you suffer from retrocalcaneal bursitis you will experience pain at the back of the heel that increases with extension and flexion of the ankle. In more severe cases, a pop or slip may be felt as the bursa moves when direct pressure is applied at the heel, for instance, from a strap of a shoe.  Relieving the symptoms of bursitis initially focuses on taking the pressure off the bursa. This can be done with proper cushioning, inserts, or footwear but may require surgery if it is a bone formation problem which is called a Haglund’s deformity.

The most important factor in healing bursitis is resting your foot and ankle. This can be difficult when you have to carry on with daily activities, but resting and elevating your foot whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that stress the back of the heel until your pain and inflammation begins to subside.  Ice, anti-inflammatory medications, immobilization, and physical therapy are common treatments for this condition.  Treatments should involve decreasing swelling, relieving pain and stress on the Achilles, correcting any biomechanical dysfunction (over-pronation or flat feet). If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper footwear to prevent further irritation or damage.