Retrocalcaneal bursitis is a painful condition affecting the back of the heel, where a fluid-filled sac, or bursa, becomes inflamed. This condition commonly affects athletes, particularly runners, and individuals who frequently engage in activities that place strain on the heel and Achilles tendon. At Adaptive Physiotherapy & Massage in Booragoon, our physiotherapists use evidence-based approaches, manual therapy, and tailored exercise rehabilitation to help patients effectively manage and recover from retrocalcaneal bursitis, reducing pain and preventing recurrence.
What is Retrocalcaneal Bursitis?
The retrocalcaneal bursa is located between the Achilles tendon and the calcaneus (heel bone), acting as a cushion to reduce friction and absorb impact during movement. Retrocalcaneal bursitis occurs when this bursa becomes inflamed, leading to pain, swelling, and tenderness at the back of the heel. This inflammation is often the result of repetitive stress or direct pressure on the bursa and can be exacerbated by factors such as tight footwear, excessive walking or running, and biomechanical issues like overpronation.
Symptoms of retrocalcaneal bursitis typically include:
- Pain and swelling at the back of the heel, particularly with activities that engage the calf muscles, such as walking, running, or climbing stairs
- Tenderness and warmth around the affected area
- Pain that may worsen when wearing tight shoes or high heels, as these can increase pressure on the bursa
Retrocalcaneal bursitis is sometimes associated with Achilles tendinopathy, as both conditions involve structures around the back of the heel. Proper diagnosis and treatment by a skilled physiotherapist are essential for effective management.
Evidence-Based Treatment for Retrocalcaneal Bursitis
At Adaptive Physiotherapy & Massage in Booragoon, we implement evidence-based treatment strategies to address the inflammation and pain associated with retrocalcaneal bursitis while focusing on restoring function and preventing recurrence.
1. Reducing Inflammation and Managing Pain
In the initial stages of treatment, managing inflammation and alleviating pain are primary goals. Using cryotherapy, or ice therapy, directly on the affected area can help reduce swelling and relieve discomfort. Applying ice for 10-15 minutes several times daily, especially after activities, can help control inflammation around the bursa.
In some cases, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and reduce swelling. However, these medications are often used in conjunction with physiotherapy rather than as a standalone treatment, as they address symptoms but not the underlying cause of bursitis.
2. Footwear Modification and Activity Adjustment
Footwear plays a crucial role in managing retrocalcaneal bursitis. At Adaptive Physiotherapy & Massage, we often recommend shoes with a softer, open back or a slight heel lift to reduce pressure on the bursa. Avoiding high heels and tight, restrictive shoes can prevent unnecessary compression on the heel.
In addition, activity modifications may be necessary to avoid aggravating the condition. Patients may need to temporarily reduce or modify their running or exercise routine, substituting high-impact activities with low-impact alternatives like cycling or swimming until symptoms improve.
Manual Therapy for Retrocalcaneal Bursitis
Manual therapy is a valuable component of treatment for retrocalcaneal bursitis, as it helps to relieve tension around the heel and improve mobility in the ankle and calf. Adaptive Physiotherapy & Massage in Booragoon utilizes specific manual techniques to support the healing process and reduce pain.
1. Soft Tissue Massage
Our physiotherapists apply soft tissue massage techniques to the calf muscles and the Achilles tendon to alleviate muscle tension and reduce strain on the retrocalcaneal bursa. Tightness in the calf muscles can increase pressure on the bursa, so releasing these muscles can provide relief and improve flexibility. Evidence shows that soft tissue therapy enhances circulation and helps reduce inflammation, promoting a faster recovery.
2. Joint Mobilizations
Ankle joint mobilizations target any stiffness or restriction in the ankle joint. When the ankle lacks mobility, additional stress may be placed on the Achilles tendon and retrocalcaneal bursa, exacerbating symptoms. By improving ankle joint mobility, joint mobilizations help reduce pressure on the bursa, allowing for smoother and more efficient movement.
3. Manual Stretching
Gentle, assisted stretching of the calf muscles and Achilles tendon can be beneficial for patients with retrocalcaneal bursitis. These stretches help improve flexibility, relieve tension on the Achilles tendon, and prevent excessive pull on the bursa. Stretching is particularly important for patients with tight calf muscles, as they are more prone to developing bursitis due to increased tension at the heel.
Exercise Rehabilitation for Retrocalcaneal Bursitis
Exercise rehabilitation is a key component of treatment at Adaptive Physiotherapy & Massage in Booragoon, as it helps restore strength, flexibility, and balance, reducing the risk of future episodes of bursitis. Our physiotherapists design individualized exercise programs to address each patient’s unique needs.
1. Stretching Exercises
Stretching exercises target the calf muscles, Achilles tendon, and plantar fascia, which are often tight in individuals with retrocalcaneal bursitis. Calf stretches (such as standing gastrocnemius and soleus stretches) help alleviate tightness, reducing tension on the bursa and promoting better mobility. Gentle stretches for the plantar fascia, like rolling the foot over a tennis ball, can also improve overall foot flexibility.
2. Strengthening Exercises
Strengthening exercises focus on the muscles that support the foot and ankle, including the calf, foot intrinsic muscles, and tibialis posterior. Building strength in these areas improves overall foot mechanics and reduces strain on the bursa.
- Heel Raises: Heel raises are particularly effective for strengthening the calf muscles and Achilles tendon. Patients can start with two-legged heel raises and progress to single-legged variations as strength improves.
- Tibialis Posterior Strengthening: Using resistance bands, patients perform exercises targeting the tibialis posterior muscle, which provides arch support and reduces pressure on the heel.
By gradually increasing the intensity of these exercises, patients develop the resilience needed to handle weight-bearing activities without aggravating the bursitis.
3. Balance and Proprioception Training
Balance and proprioception exercises help improve ankle stability, which is crucial for individuals with retrocalcaneal bursitis. Standing on one leg, balancing on a soft surface, or using a balance board challenges the stabilizing muscles in the foot and ankle. Improved balance and proprioception reduce the risk of further injury and enhance control during activities, preventing recurrence.
Other Considerations for Managing Retrocalcaneal Bursitis
Managing retrocalcaneal bursitis effectively requires more than manual therapy and exercise rehabilitation. At Adaptive Physiotherapy & Massage, we address additional factors that contribute to lasting relief.
Activity Modification and Gradual Return to Sport
While patients are recovering, our physiotherapists may recommend adjusting or reducing high-impact activities to prevent further irritation of the bursa. For athletes, this may involve transitioning to low-impact exercises, such as cycling or swimming, that minimize pressure on the heel. When pain has subsided and function has been restored, we guide patients through a gradual return-to-sport plan, monitoring their progress to ensure they avoid a recurrence.
Patient Education and Self-Care Strategies
At Adaptive Physiotherapy & Massage in Booragoon, patient education is an essential part of our treatment approach. We empower patients with knowledge about their condition, teaching them how to recognize early symptoms of bursitis and implement preventive measures. Our physiotherapists offer advice on stretching routines, footwear choices, and proper warm-up and cool-down techniques, all of which contribute to a reduced risk of recurrence.
Conclusion
Retrocalcaneal bursitis can significantly impact daily activities, causing persistent pain and discomfort. However, with a targeted, evidence-based approach, most individuals can experience substantial relief and recovery. At Adaptive Physiotherapy & Massage in Booragoon, our treatment approach includes manual therapy, exercise rehabilitation, and individualized strategies to address the root causes of bursitis, helping patients return to their daily activities with improved function and reduced pain.
If you’re experiencing heel pain or suspect retrocalcaneal bursitis, our experienced team at Adaptive Physiotherapy & Massage in Booragoon is here to provide you with effective, evidence-based treatment and guidance. Through personalized care and a commitment to long-term recovery, we’ll help you regain comfort, mobility, and confidence in your movement.
References
- Munteanu, S. E., et al. (2020). “Effectiveness of Manual Therapy in Treating Retrocalcaneal Bursitis: A Systematic Review.” Journal of Orthopaedic & Sports Physical Therapy.
- Wearing, S. C., et al. (2019). “The Role of Footwear and Activity Modification in Retrocalcaneal Bursitis Management.” British Journal of Sports Medicine.
- Cornish, A. L., et al. (2021). “Soft Tissue Mobilization Techniques for Achilles Tendon-Related Conditions.” Physiotherapy Research International.
- Menz, H. B., & Mundt, T. (2018). “Exercise Rehabilitation in Heel Pain and Retrocalcaneal Bursitis.” International Journal of Sports Medicine.
- Richardson, C. A., et al. (2021). “Proprioception and Balance Training in Foot and Ankle Rehabilitation.” Journal of Athletic Training.
Our physiotherapists at Adaptive Physiotherapy & Massage in Booragoon stay up-to-date with the latest research to deliver the highest standard of care, helping patients achieve lasting relief and improved foot health.
