Plantar calcaneal bursitis is a medical condition in which there is inflammation of the plantar calcaneal bursa, a spongy fluid filled sac that cushions the fascia of the heel and the calcaneus (heel
bone). It is characterized by swelling and tenderness of the central plantar heel area. It is sometimes called 'Policeman's heel'. It sometimes was, and should not be, confused with plantar
fasciitis, which is inflammation of the plantar fascia and can affect any part of the foot.
Bursitis is caused by overuse or excessive pressure on the joint, injury, infection, or an underlying condition, such as osteoarthritis, rheumatoid arthritis, gout, pseudogout, or ankylosing
spondylitis. When bursitis is caused by an underlying condition, the condition must be treated along with the bursitis. When bursitis is caused by infection, called septic bursitis, medical treatment
and antibiotics are necessary.
The main symptom of heel bursitis is pain. You may experience pain in your heel when you walk or run. There may also be pain if the area is touched or if you stand on your tiptoes. In addition to
pain, the area may appear red and warm, which are both signs of inflammation. Even if you have these symptoms, only a doctor can determine if you have bursitis of the heel. Your doctor will use these
symptoms along with a general exam to determine if you are suffering from bursitis of the heel.
Your doctor will examine you, including an evaluation of your gait, while you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk.
An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration,
muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your
health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment.
Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.
Non Surgical Treatment
The following exercises are commonly prescribed to patients with retrocalcaneal bursitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them.
Generally, they should be performed 2, 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises
and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no
increase in symptoms. Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no
increase in symptoms. Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no
increase in symptoms. Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times in both clockwise and
anticlockwise directions provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back
should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and
provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise
is pain free.
Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.