Heel Bursitis

Overview

What is bursitis of the heel?

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.

There’s a bursa behind both of your ankles near your heel bone (calcaneus). It’s located in the space between your heel bone and your Achilles tendon. It’s called the retrocalcaneal (behind the heel) bursa.

Bursitis happens when a bursa becomes irritated and causes pain. Heel bursitis is specific to the bursa in your heel. It causes foot and heel pain.

Who does heel bursitis affect?

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

It is 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:

How common is heel bursitis?

Heel bursitis is a common condition. It frequently occurs in athletes who run a lot. It also affects athletes who perform repetitive foot and ankle movements, like dancing.

How does heel bursitis affect my body?

Heel bursitis can be painful. If you have heel bursitis, it can be difficult to make certain movements. Walking, running and jumping may be painful.

Symptoms and Causes

What are the symptoms of heel bursitis?

Symptoms of heel bursitis may include:

  • Pain and swelling in or behind your heel.
  • Tenderness.
  • Increased pain when standing on your toes.
  • Your heel and the surrounding area feel warm to the touch.
  • Change in skin color around your heel.

What causes heel bursitis?

Heel bursitis has many causes:

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

Is heel bursitis contagious?

Heel bursitis is not contagious. In rare cases, a bacterial infection can cause heel bursitis. But this infection isn’t passed from person to person. It typically happens when Staphylococcus (staph) bacteria enters the body from a cut near your foot. It is important to wash small open wounds with clean running water and soap. Then, use a cotton swab to apply a small amount of petroleum jelly (Vaseline™) or skin care ointment (Aquaphor™) over the wound, and cover it with an adhesive bandage to prevent dirt or bacteria from entering the area.

Diagnosis and Tests

How is heel bursitis diagnosed?

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

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

Your healthcare provider will examine your foot. They will:

  • 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 healthcare 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). They will 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. They 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. Abnormalities may affect how your foot moves. The presence of an abnormality or a separate disorder can increase your risk of developing heel bursitis.
  • Magnetic resonance imaging (MRI): An MRI can determine if the cause of your heel pain is from something other than heel bursitis, such as Achilles tendinitis.

Management and Treatment

How is heel bursitis treated?

Heel bursitis treatment depends on what’s causing your pain. Treatment may include:

  • Orthotics: Heel wedges encourage proper walking form and reduce irritation in your heel. You can buy heel wedges in a store. Your healthcare provider 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 may all provide relief. Calf, ankle and foot exercises strengthen your Achilles tendon and the surrounding area. This also takes pressure off your bursa.
  • Corticosteroids: In rare cases, your healthcare provider may inject a corticosteroid into your heel. This will decrease inflammation.
  • Surgery: Surgery is rarely needed. However, if your pain hasn’t improved in six to 12 months, you may have to see a foot and ankle surgeon. They may surgically remove the affected bursa (bursectomy).
  • Antibiotics: If an infection caused your bursitis, your healthcare provider will prescribe oral antibiotics.

How can I relieve heel bursitis pain?

You can relieve pain and inflammation 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 an Achilles notch in the back collar to protect your Achilles tendon. Shoes with proper arch support will also take stress off your Achilles tendon.
  • Medications: Over-the-counter non-steroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen and naproxen, will reduce the pain and inflammation associated with your heel bursitis. Not everyone can take NSAIDs, so it’s a good idea to check with your healthcare provider before use.

How soon after treatment will I feel better?

In most cases, you should feel better after several weeks of proper treatment.

Prevention

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. Avoid walking and running on hard surfaces, like concrete or asphalt. A rubber track or grass is easier on your body.

Outlook / Prognosis

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.

Living With

What questions should I ask my healthcare provider?

  • Why did this happen to me?
  • What activities should I avoid? For how long?
  • What can I do to manage my pain?
  • What treatments do you recommend?
  • Was it caused by an infection?
  • Do you think I should have surgery?

A note from Cleveland Clinic

Heel bursitis is a common injury in athletes, active people and people who stand a lot. If you have pain in or around your heel, talk to your healthcare provider. Rest, stretching and strengthening exercises may reduce pain in your foot and ankle. If conservative treatment doesn’t provide relief or if heel pain develops at the same as a fever or chills, talk to your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 08/17/2021.

References

  • Choo YJ, Park CH, Chang MC. Rearfoot disorders and conservative treatment: a narrative review. (https://pubmed.ncbi.nlm.nih.gov/32787369/) Ann Palliat Med. 2020; 9(5): 3546-3552. Accessed 9/1/2021.
  • Sokolosky MC. Soft Tissue Problems of the Foot. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill.
  • The Spine, Pelvis, and Extremities. In: Suneja M, Szot JF, LeBlond RF, Brown DD. eds. DeGowin’s Diagnostic Examination, 11e. McGraw Hill.

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