Section 5. Bone, Joint, and Muscle Disorders

Chapter 72. Foot Problems

Topics: Introduction | Foot Pain | Ankle Sprain | Tarsal Tunnel Syndrome | Plantar Fasciitis | Achilles Tendon Bursitis | Ingrown Toenail | Onychomycosis | Onychia | Corns and Calluses | Onychauxis and Onychogryphosis | Hallux Valgus and Bunion | Hammer Toe | Sesamoiditis

Achilles Tendon Bursitis

Achilles tendon bursitis is inflammation of the fluid-filled sac (bursa) located either between the skin of the heel and the Achilles tendon (posterior Achilles tendon bursitis) or in front of the attachment of the Achilles tendon to the heel bone (anterior Achilles tendon bursitis, retrocalcaneal bursitis).

The Achilles tendon is the tendon that attaches the calf muscles to the heel bone. Posterior Achilles tendon bursitis is often associated with formation of a spur called Haglund's deformity or "pump bump" on the heel bone. Anterior Achilles tendon bursitis is also called Albert's disease.

See the figure Bursitis in the Heel.

Posterior Achilles tendon bursitis occurs mainly in young women but can develop in men. Walking in a way that repeatedly presses the soft tissue behind the heel against the stiff back support of a shoe can cause or aggravate the bursitis. Shoes that taper sharply inward toward the posterior heel (such as high-heeled shoes) can lead to the development of this bursitis.

Any condition that puts extra strain on the Achilles tendon can cause anterior Achilles tendon bursitis. Injuries to the heel and diseases such as rheumatoid arthritis can also cause it.

Symptoms

When the bursa becomes inflamed after an injury, symptoms usually develop suddenly; when it develops without an injury, symptoms may develop gradually. With both posterior and anterior Achilles tendon bursitis, symptoms usually include swelling and warmth at the back of the heel. A mildly red, swollen, tender spot develops on the back of the heel. When the inflamed bursa enlarges, it appears as a red lump under the skin of the heel and causes pain at and above the heel. If the condition becomes chronic, the swelling may harden.

Diagnosis and Treatment

Diagnosis is suspected on the basis of the symptoms and the clinical examination. For anterior and posterior Achilles tendon bursitis, x-rays are needed to rule out a fracture of the heel bone or damage to the heel bone due to rheumatoid arthritis or another inflammatory arthritis.

With posterior Achilles tendon bursitis, treatment is aimed at reducing the inflammation and adjusting the foot's position in the shoe to relieve pressure on the heel. Foam rubber or felt heel pads can be placed in the shoe to eliminate pressure by elevating the heel. Stretching the back part of the shoe or placing padding around the inflamed bursa may help. Sometimes a special shoe, such as a running shoe designed to stabilize the midsole heel, can help to control abnormal heel motion. Other shoes have padding that reduces irritation to the posterior heel and Achilles tendon.

With anterior and posterior Achilles tendon bursitis, applying warm or cool compresses to the area and using nonsteroidal anti-inflammatory drugs (NSAIDs) can temporarily relieve the pain and inflammation, as can injections of a mixture of corticosteroids and local anesthetics into the inflamed bursa; the doctor is careful not to inject the mixture into the tendon. After this treatment, the person must rest. When these treatments are not effective, part of the heel bone may need to be surgically removed.