Heel Bursitis

Heel bursitis (pronounced “ber-CY-tuss”) is a condition that occurs when a bursa in your heel becomes irritated and inflamed. This inflammation can cause foot, ankle and heel pain.

A bursa is a small, slippery sac in your body that’s filled with fluid. Bursae (plural form of bursa) act as a cushion and lubricant. They protect bones from rubbing or sliding against tendons, muscles or skin.

Bursitis can affect any of the bursae in your body. There are bursae behind both of your ankles near your heel bone (calcaneus). Fortunately, there are at-home and other nonsurgical options to treat the condition.

Types of heel bursitis

There are two main types of heel bursitis:

• Retrocalcaneal bursitis. This is the more common type. It happens when the bursa between your heel bone and Achilles tendon becomes inflamed. It’s also known as Achilles tendon bursitis.
• Subcutaneous calcaneal bursitis. This type of heel bursitis occurs when the bursa between your skin and Achilles tendon becomes inflamed.

Symptoms of heel bursitis

Heel bursitis symptoms may include:

• Pain and swelling in or behind your heel
• Tenderness
• Increased pain when standing on your toes
• Warmth around your heel and the surrounding area
• Change in skin color around your heel

Heel bursitis causes

Heel bursitis has many causes, including:

• Standing, walking, running or jumping a lot
• Quickly increasing the intensity of your activities or workouts
• Not properly stretching
• Tight-fitting shoes
• Bacterial infection

Risk factors for heel bursitis

Heel bursitis most frequently affects people who overuse their ankles without proper conditioning. A sudden increase in walking, running or jumping can cause heel bursitis.

It’s important to wear proper footwear, especially when practicing a sport or exercising. Tight-fitting shoes can cause heel bursitis.

Heel bursitis can also affect those who have other disorders, including:

• Haglund’s deformity
• Rheumatoid arthritis
• Ankylosing spondylitis (AS)
• Psoriatic arthritis
• Reactive arthritis (formerly known as Reiter’s syndrome)
• Pseudogout
• Gout

How doctors diagnose heel bursitis

Before examining your foot, your healthcare provider may ask several questions, including:

• Do you stand a lot?
• What do you do for physical activity?
• What types of shoes do you wear?
• Have you had heel bursitis before?

Your provider will examine your foot. They’ll:

• Check for swelling
• Note any tender or painful areas
• Check your foot’s range of motion
• Ask you to stand on your toes or flex your feet

If your provider suspects that you have a bacterial infection, they may:

• Ask if you have chills
• Check your temperature
• Remove some fluid from the heel bursa with a syringe (bursal aspiration)
• Test the fluid for the presence of bacteria

What tests will be done to diagnose heel bursitis?

Imaging tests can help your healthcare provider confirm heel bursitis. These tests may include:

• X-rays. An X-ray will show a detailed image of your heel bone. Your healthcare provider will examine the X-ray for any abnormalities in your heel bone.
• Magnetic resonance imaging (MRI). An MRI can determine if the cause of your heel pain is from something other than heel bursitis, like Achilles tendinitis.
• Ultrasound. An ultrasound can show your bursae, as well as the muscles, tendons and ligaments in your heel.

How is heel bursitis treated?

Heel bursitis treatment depends on what’s causing your pain.

You may be able to relieve pain and inflammation on your own with:

• Rest. Stop any activities that cause or worsen pain, including walking, running or jumping. This will give the bursa time to heal.
• Ice. Apply an ice pack covered in a light towel to your heel and ankle for up to 20 minutes three to four times per day.
• Proper footwear. Don’t wear shoes that are too tight or have a stiff heel. Wear shoes with a U- or V-shaped indentation in the back collar to protect your Achilles tendon.
• Medications. Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs), like ibuprofen and naproxen, may reduce the pain and inflammation.

Your healthcare provider may treat heel bursitis with:

• Orthotics. Heel wedges encourage proper walking form and reduce irritation in your heel. You can buy heel wedges in a store. Your podiatrist can also make custom heel wedges for your foot.
• Physical therapy. Stretching your Achilles tendon will take pressure off your heel bursa. Calf stretches, toe-to-wall stretches and heel drop stretches — as well as strengthening — may all provide relief.
• Antibiotics. If an infection caused your bursitis, your healthcare provider will prescribe oral antibiotics.
• Bursa injections. In rare cases, your healthcare provider may inject a steroid into your heel. This will decrease inflammation.
• Surgery. Surgery is rarely needed. But if your pain hasn’t improved in six to 12 months, you may have to see a foot and ankle surgeon to surgically remove the affected bursa (bursectomy).

What questions should I ask my healthcare provider?

Questions you may want to ask your provider about heel bursitis include:

• What caused heel bursitis?
• What can I do to manage my pain?
• What treatments do you recommend?
• What activities should I avoid? For how long?

How can I reduce my risk of heel bursitis?

You can reduce your risk of developing heel bursitis by:

• Stretching and warming up before exercising
• Wearing proper footwear when exercising
• Walking and running on soft surfaces

What can I expect if I have heel bursitis?

With proper diagnosis and treatment, the outlook for people with heel bursitis is good. Most people feel better after two to three weeks of home treatment. More serious cases may take six to 12 months.