The most common pathologic condition that is related to the pain at the posterior heel or ankle is the one of the posterior calcaneus, specifically at the place where Achilles tendon inserts into the bone, or its associated bursae. There are two bursae around the Achilles insertion the retrocalcaneal (subtendinous) bursa, which is anterior to the tendon, between the Achilles and the calcaneus, and the subcutaneous calcaneal bursa (also known as the Achilles bursa) which is posterior to the tendon between the skin and the distal Achilles. One or both bursae may become inflamed resulting in pain in the posterior heel and ankle area. Bursae, whether subcutaneous or retrocalcaneal, of patients with insertional Achilles tendinopathy may be thickened, and have increased vascularity of their walls. Most often these people also appear with Haglund deformities.
Epidemiology
Retrocalcaneal bursitis is a widespread chronic overuse injury in athletes of different levels of skills. In cross-sectional study, Campanelli et al. found that retrocalcaneal bursitis was the most frequent lower-extremity overuse condition in figure skaters. Haglund syndrome and retro calcaneal bursitis have also been reported among hockey players who are presumably due to recurrent mechanical stress on the posterior foot occasioned by ice skates.
Anatomy
Pathophysiology
Retrocalcaneal bursitis is primarily an overuse and mechanical overload condition that affects the bursa located between the Achilles tendon and the posterior aspect of the calcaneus. Repetitive stress, such as excessive running or jumping, can lead to microtrauma at the bursa, resulting in inflammation, fluid accumulation, and thickening of the bursal walls.
The mechanical causes which contribute to the pressure at the posterior heel and to the aggravation of the irritation of bursa are tight or ill-fitting shoes. The anatomical abnormality, including Haglund deformity, may also contribute by impingement of Achilles tendon against the posterosuperior calcaneal prominence during dorsiflexion. This rupture enhances tension and strain on retro calcaneal bursa continuing inflammation.
Altered biomechanics, such as subtalar joint misalignment, can also create uneven force distribution across the Achilles tendon and surrounding structures. This asymmetry leads to additional stress on the bursa, predisposing it to chronic inflammation and contributing to associated conditions like insertional Achilles tendinopathy. Chronic inflammation may result in fibrosis and persistent pain if left untreated.
Etiology
Retrocalcaneal bursitis can result from a variety of mechanical and anatomical factors. Excessive increase in running mileage may also be classified as overtraining and can cause repetitive stress to the posterior heel and can also cause bursitis. On the same note, shoes that are tight or ill-fitting with a tight heel counter may overload the posterior heel and ankle leading to inflammation.
Gaining an excessive size of the posterior super-posterior calcaneal prominence is a Haglund deformity, which may result in Achilles tendon impingement during dorsiflexion, causing retrocalcaneal bursitis. This deformity combined with retro calcaneal bursitis and insertional Achilles tendinosis is known as the Haglund syndrome.
Additionally, subtalar joint misalignment, as measured by deviations in joint axis inclination relative to the Achilles tendon, can create asymmetrical force distribution on the tendon, disrupting normal biomechanics and increasing the risk of Achilles-related pathologies, including bursitis.
Genetics
Prognostic Factors
The majority of the patients with retrocalcaneal bursitis improve considerably under conservative techniques such as local icing, oral nonsteroidal anti-inflammatory drugs, Achilles tendon stretching and proper modification of the footwear. In those patients who experience intractable symptoms despite these nonsurgical procedures, surgical therapy with bursectomy or other forms of procedures as mentioned earlier usually offers successful remedy.
Clinical History
Retrocalcaneal bursitis may be present in patients of any age, but it is most prevalent among teenagers and adults performing the same activity involving loading the heel repeatedly, like running, jumping, or figure skating. Research involving figure skaters has revealed that the condition is more common among those children who are above nine years of age and greater prevalence among elite athletes than among non-elite athletes. It is also less frequent, but it may occur in older adults, especially those with chronic biomechanical anomalies, or a predisposing anatomical structure (Haglund deformity).
The Retrocalcaneal bursitis is often linked to high impact forms of sports and activities that impose repetitive stress on the back of the heel such as running, figure skating and ice hockey. Haglund deformity or subtalar joint malalignment are also anatomical factors that predispose people even more. The disorder usually accompanies the presence of insertional Achilles tendinopathy, Haglund syndrome, and other Achilles-related disorders, especially in athletes or people having chronic overuse.
Physical Examination
In physical examination, patients with retrocalcaneal bursitis usually have localized tenderness in anterior of the Achilles tendon at the position of its insertion on the calcaneus. There may be swelling or fullness of this area and in few cases, erythema can be detected. Pain on palpation may be aggravated with passive dorsiflexion of the ankle, creating additional pressure on the retrocalcaneal bursa.
Age group
Associated comorbidity
The Retrocalcaneal bursitis is often linked to high impact forms of sports and activities that impose repetitive stress on the back of the heel such as running, figure skating and ice hockey. Haglund deformity or subtalar joint malalignment are also anatomical factors that predispose people even more. The disorder usually accompanies the presence of insertional Achilles tendinopathy, Haglund syndrome, and other Achilles-related disorders, especially in athletes or people having chronic overuse.
Associated activity
Acuity of presentation
Retrocalcaneal bursitis is characterized by the onset of pain at the back of the heel, which increases with the activity (running, jumping, or sitting down). The patients can complain of rigidity, particularly in the morning or following a time of immobility. Tenderness, pitting, just in front of the Achilles tendon, and slight erythema can be noticed. The condition may be acute in certain instances when there has been an acute onset of activity or direct impact on the posterior heel but in the majority of the cases, it is a chronic and progressive onset condition. The ankle causes pain that tends to restrict activities that involve ankle dorsiflexion and can affect performance in sports.
Differential Diagnoses
Insertional Achilles Tendinopathy
Haglund Syndrome
Sever’s Disease (Calcaneal Apophysitis)
Calcaneal Stress Fracture
Posterior Ankle Impingement Syndrome
Subcutaneous Calcaneal Bursitis
Retrocalcaneal Infection or Septic Bursitis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Most patients respond well to conservative management, including rest, activity modification, local ice therapy, oral anti-inflammatory medications, Achilles tendon stretching, and appropriate footwear or heel lifts to reduce pressure. When patients have persistent or refractory symptoms, surgical procedures (retrocalcaneal bursectomy, excision of a Haglund deformity, and repair of related insertional Achilles tendinopathy) have the potential to offer a beneficial effect.
Environmental and activity modifications play an important role in the management and prevention of retrocalcaneal bursitis. Adjustments include selecting proper footwear with a cushioned heel, adequate heel counter flexibility, and appropriate sizing to reduce posterior heel pressure. Use of heel lifts or orthotic inserts can help decrease strain on the Achilles tendon and bursa. Modifying training surfaces to softer or more forgiving terrain, reducing high-impact activities, and gradually increasing training intensity can also minimize repetitive stress. In sports settings, ensuring well-fitted protective gear such as skates or boots that do not compress the posterior heel is crucial in preventing exacerbation. Environmental and equipment changes, combined with activity modification, support conservative management and reduce recurrence risk.
Effectiveness of Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) in treating
Ketoprofen
Ketoprofen is applied in the treatment of mild to moderate pain and inflammation. Small initial dosages are suggested particularly in children, elderly patients, or those patients with renal or liver impairment. The therapeutic effect is not increased at doses above 75 mg. They should be administered in high doses but with close observation of the reaction of the patient.
Naproxen (Aleve, Anaprox, Anaprox DS)
Naproxen is indicated for mild to moderate pain and functions by inhibiting cyclooxygenase activity, which reduces prostaglandin synthesis and thereby decreases inflammation and pain.
Effectiveness of Topical Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in treating
Topical NSAIDs deliver a high concentration of anti-inflammatory medication directly to a localized area of pain, minimizing systemic exposure.
Diclofenac Topical (Flector Transdermal Patch, Licart, Pennsaid Topical Solution)
Diclofenac inhibits inflammatory reactions and reduces pain by decreasing prostaglandin synthesis. It is commonly used for localized musculoskeletal pain, including conditions like retrocalcaneal bursitis.
role-of-management-in-treating
Management of retrocalcaneal bursitis typically follows a phased approach. The acute phase focuses on pain relief and reduction of inflammation through rest, ice therapy, nonsteroidal anti-inflammatory medications, and temporary activity modification. The subacute or rehabilitation phase emphasizes stretching and strengthening of the Achilles tendon, correction of biomechanical abnormalities, and gradual return to activity with appropriate footwear and orthotic support. The chronic or refractory phase involves more advanced interventions for patients who do not respond to conservative measures, including surgical options such as retrocalcaneal bursectomy, excision of a Haglund deformity, or treatment of associated insertional Achilles tendinopathy. Each phase is tailored to symptom severity, activity level, and underlying anatomical factors, with the goal of restoring function and preventing recurrence.
The most common pathologic condition that is related to the pain at the posterior heel or ankle is the one of the posterior calcaneus, specifically at the place where Achilles tendon inserts into the bone, or its associated bursae. There are two bursae around the Achilles insertion the retrocalcaneal (subtendinous) bursa, which is anterior to the tendon, between the Achilles and the calcaneus, and the subcutaneous calcaneal bursa (also known as the Achilles bursa) which is posterior to the tendon between the skin and the distal Achilles. One or both bursae may become inflamed resulting in pain in the posterior heel and ankle area. Bursae, whether subcutaneous or retrocalcaneal, of patients with insertional Achilles tendinopathy may be thickened, and have increased vascularity of their walls. Most often these people also appear with Haglund deformities.
Retrocalcaneal bursitis is a widespread chronic overuse injury in athletes of different levels of skills. In cross-sectional study, Campanelli et al. found that retrocalcaneal bursitis was the most frequent lower-extremity overuse condition in figure skaters. Haglund syndrome and retro calcaneal bursitis have also been reported among hockey players who are presumably due to recurrent mechanical stress on the posterior foot occasioned by ice skates.
Retrocalcaneal bursitis is primarily an overuse and mechanical overload condition that affects the bursa located between the Achilles tendon and the posterior aspect of the calcaneus. Repetitive stress, such as excessive running or jumping, can lead to microtrauma at the bursa, resulting in inflammation, fluid accumulation, and thickening of the bursal walls.
The mechanical causes which contribute to the pressure at the posterior heel and to the aggravation of the irritation of bursa are tight or ill-fitting shoes. The anatomical abnormality, including Haglund deformity, may also contribute by impingement of Achilles tendon against the posterosuperior calcaneal prominence during dorsiflexion. This rupture enhances tension and strain on retro calcaneal bursa continuing inflammation.
Altered biomechanics, such as subtalar joint misalignment, can also create uneven force distribution across the Achilles tendon and surrounding structures. This asymmetry leads to additional stress on the bursa, predisposing it to chronic inflammation and contributing to associated conditions like insertional Achilles tendinopathy. Chronic inflammation may result in fibrosis and persistent pain if left untreated.
Retrocalcaneal bursitis can result from a variety of mechanical and anatomical factors. Excessive increase in running mileage may also be classified as overtraining and can cause repetitive stress to the posterior heel and can also cause bursitis. On the same note, shoes that are tight or ill-fitting with a tight heel counter may overload the posterior heel and ankle leading to inflammation.
Gaining an excessive size of the posterior super-posterior calcaneal prominence is a Haglund deformity, which may result in Achilles tendon impingement during dorsiflexion, causing retrocalcaneal bursitis. This deformity combined with retro calcaneal bursitis and insertional Achilles tendinosis is known as the Haglund syndrome.
Additionally, subtalar joint misalignment, as measured by deviations in joint axis inclination relative to the Achilles tendon, can create asymmetrical force distribution on the tendon, disrupting normal biomechanics and increasing the risk of Achilles-related pathologies, including bursitis.
The majority of the patients with retrocalcaneal bursitis improve considerably under conservative techniques such as local icing, oral nonsteroidal anti-inflammatory drugs, Achilles tendon stretching and proper modification of the footwear. In those patients who experience intractable symptoms despite these nonsurgical procedures, surgical therapy with bursectomy or other forms of procedures as mentioned earlier usually offers successful remedy.
Retrocalcaneal bursitis may be present in patients of any age, but it is most prevalent among teenagers and adults performing the same activity involving loading the heel repeatedly, like running, jumping, or figure skating. Research involving figure skaters has revealed that the condition is more common among those children who are above nine years of age and greater prevalence among elite athletes than among non-elite athletes. It is also less frequent, but it may occur in older adults, especially those with chronic biomechanical anomalies, or a predisposing anatomical structure (Haglund deformity).
The Retrocalcaneal bursitis is often linked to high impact forms of sports and activities that impose repetitive stress on the back of the heel such as running, figure skating and ice hockey. Haglund deformity or subtalar joint malalignment are also anatomical factors that predispose people even more. The disorder usually accompanies the presence of insertional Achilles tendinopathy, Haglund syndrome, and other Achilles-related disorders, especially in athletes or people having chronic overuse.
In physical examination, patients with retrocalcaneal bursitis usually have localized tenderness in anterior of the Achilles tendon at the position of its insertion on the calcaneus. There may be swelling or fullness of this area and in few cases, erythema can be detected. Pain on palpation may be aggravated with passive dorsiflexion of the ankle, creating additional pressure on the retrocalcaneal bursa.
The Retrocalcaneal bursitis is often linked to high impact forms of sports and activities that impose repetitive stress on the back of the heel such as running, figure skating and ice hockey. Haglund deformity or subtalar joint malalignment are also anatomical factors that predispose people even more. The disorder usually accompanies the presence of insertional Achilles tendinopathy, Haglund syndrome, and other Achilles-related disorders, especially in athletes or people having chronic overuse.
Retrocalcaneal bursitis is characterized by the onset of pain at the back of the heel, which increases with the activity (running, jumping, or sitting down). The patients can complain of rigidity, particularly in the morning or following a time of immobility. Tenderness, pitting, just in front of the Achilles tendon, and slight erythema can be noticed. The condition may be acute in certain instances when there has been an acute onset of activity or direct impact on the posterior heel but in the majority of the cases, it is a chronic and progressive onset condition. The ankle causes pain that tends to restrict activities that involve ankle dorsiflexion and can affect performance in sports.
Insertional Achilles Tendinopathy
Haglund Syndrome
Sever’s Disease (Calcaneal Apophysitis)
Calcaneal Stress Fracture
Posterior Ankle Impingement Syndrome
Subcutaneous Calcaneal Bursitis
Retrocalcaneal Infection or Septic Bursitis
Most patients respond well to conservative management, including rest, activity modification, local ice therapy, oral anti-inflammatory medications, Achilles tendon stretching, and appropriate footwear or heel lifts to reduce pressure. When patients have persistent or refractory symptoms, surgical procedures (retrocalcaneal bursectomy, excision of a Haglund deformity, and repair of related insertional Achilles tendinopathy) have the potential to offer a beneficial effect.
Sports Medicine
Environmental and activity modifications play an important role in the management and prevention of retrocalcaneal bursitis. Adjustments include selecting proper footwear with a cushioned heel, adequate heel counter flexibility, and appropriate sizing to reduce posterior heel pressure. Use of heel lifts or orthotic inserts can help decrease strain on the Achilles tendon and bursa. Modifying training surfaces to softer or more forgiving terrain, reducing high-impact activities, and gradually increasing training intensity can also minimize repetitive stress. In sports settings, ensuring well-fitted protective gear such as skates or boots that do not compress the posterior heel is crucial in preventing exacerbation. Environmental and equipment changes, combined with activity modification, support conservative management and reduce recurrence risk.
Ketoprofen
Ketoprofen is applied in the treatment of mild to moderate pain and inflammation. Small initial dosages are suggested particularly in children, elderly patients, or those patients with renal or liver impairment. The therapeutic effect is not increased at doses above 75 mg. They should be administered in high doses but with close observation of the reaction of the patient.
Naproxen (Aleve, Anaprox, Anaprox DS)
Naproxen is indicated for mild to moderate pain and functions by inhibiting cyclooxygenase activity, which reduces prostaglandin synthesis and thereby decreases inflammation and pain.
Topical NSAIDs deliver a high concentration of anti-inflammatory medication directly to a localized area of pain, minimizing systemic exposure.
Diclofenac Topical (Flector Transdermal Patch, Licart, Pennsaid Topical Solution)
Diclofenac inhibits inflammatory reactions and reduces pain by decreasing prostaglandin synthesis. It is commonly used for localized musculoskeletal pain, including conditions like retrocalcaneal bursitis.
Management of retrocalcaneal bursitis typically follows a phased approach. The acute phase focuses on pain relief and reduction of inflammation through rest, ice therapy, nonsteroidal anti-inflammatory medications, and temporary activity modification. The subacute or rehabilitation phase emphasizes stretching and strengthening of the Achilles tendon, correction of biomechanical abnormalities, and gradual return to activity with appropriate footwear and orthotic support. The chronic or refractory phase involves more advanced interventions for patients who do not respond to conservative measures, including surgical options such as retrocalcaneal bursectomy, excision of a Haglund deformity, or treatment of associated insertional Achilles tendinopathy. Each phase is tailored to symptom severity, activity level, and underlying anatomical factors, with the goal of restoring function and preventing recurrence.
The most common pathologic condition that is related to the pain at the posterior heel or ankle is the one of the posterior calcaneus, specifically at the place where Achilles tendon inserts into the bone, or its associated bursae. There are two bursae around the Achilles insertion the retrocalcaneal (subtendinous) bursa, which is anterior to the tendon, between the Achilles and the calcaneus, and the subcutaneous calcaneal bursa (also known as the Achilles bursa) which is posterior to the tendon between the skin and the distal Achilles. One or both bursae may become inflamed resulting in pain in the posterior heel and ankle area. Bursae, whether subcutaneous or retrocalcaneal, of patients with insertional Achilles tendinopathy may be thickened, and have increased vascularity of their walls. Most often these people also appear with Haglund deformities.
Retrocalcaneal bursitis is a widespread chronic overuse injury in athletes of different levels of skills. In cross-sectional study, Campanelli et al. found that retrocalcaneal bursitis was the most frequent lower-extremity overuse condition in figure skaters. Haglund syndrome and retro calcaneal bursitis have also been reported among hockey players who are presumably due to recurrent mechanical stress on the posterior foot occasioned by ice skates.
Retrocalcaneal bursitis is primarily an overuse and mechanical overload condition that affects the bursa located between the Achilles tendon and the posterior aspect of the calcaneus. Repetitive stress, such as excessive running or jumping, can lead to microtrauma at the bursa, resulting in inflammation, fluid accumulation, and thickening of the bursal walls.
The mechanical causes which contribute to the pressure at the posterior heel and to the aggravation of the irritation of bursa are tight or ill-fitting shoes. The anatomical abnormality, including Haglund deformity, may also contribute by impingement of Achilles tendon against the posterosuperior calcaneal prominence during dorsiflexion. This rupture enhances tension and strain on retro calcaneal bursa continuing inflammation.
Altered biomechanics, such as subtalar joint misalignment, can also create uneven force distribution across the Achilles tendon and surrounding structures. This asymmetry leads to additional stress on the bursa, predisposing it to chronic inflammation and contributing to associated conditions like insertional Achilles tendinopathy. Chronic inflammation may result in fibrosis and persistent pain if left untreated.
Retrocalcaneal bursitis can result from a variety of mechanical and anatomical factors. Excessive increase in running mileage may also be classified as overtraining and can cause repetitive stress to the posterior heel and can also cause bursitis. On the same note, shoes that are tight or ill-fitting with a tight heel counter may overload the posterior heel and ankle leading to inflammation.
Gaining an excessive size of the posterior super-posterior calcaneal prominence is a Haglund deformity, which may result in Achilles tendon impingement during dorsiflexion, causing retrocalcaneal bursitis. This deformity combined with retro calcaneal bursitis and insertional Achilles tendinosis is known as the Haglund syndrome.
Additionally, subtalar joint misalignment, as measured by deviations in joint axis inclination relative to the Achilles tendon, can create asymmetrical force distribution on the tendon, disrupting normal biomechanics and increasing the risk of Achilles-related pathologies, including bursitis.
The majority of the patients with retrocalcaneal bursitis improve considerably under conservative techniques such as local icing, oral nonsteroidal anti-inflammatory drugs, Achilles tendon stretching and proper modification of the footwear. In those patients who experience intractable symptoms despite these nonsurgical procedures, surgical therapy with bursectomy or other forms of procedures as mentioned earlier usually offers successful remedy.
Retrocalcaneal bursitis may be present in patients of any age, but it is most prevalent among teenagers and adults performing the same activity involving loading the heel repeatedly, like running, jumping, or figure skating. Research involving figure skaters has revealed that the condition is more common among those children who are above nine years of age and greater prevalence among elite athletes than among non-elite athletes. It is also less frequent, but it may occur in older adults, especially those with chronic biomechanical anomalies, or a predisposing anatomical structure (Haglund deformity).
The Retrocalcaneal bursitis is often linked to high impact forms of sports and activities that impose repetitive stress on the back of the heel such as running, figure skating and ice hockey. Haglund deformity or subtalar joint malalignment are also anatomical factors that predispose people even more. The disorder usually accompanies the presence of insertional Achilles tendinopathy, Haglund syndrome, and other Achilles-related disorders, especially in athletes or people having chronic overuse.
In physical examination, patients with retrocalcaneal bursitis usually have localized tenderness in anterior of the Achilles tendon at the position of its insertion on the calcaneus. There may be swelling or fullness of this area and in few cases, erythema can be detected. Pain on palpation may be aggravated with passive dorsiflexion of the ankle, creating additional pressure on the retrocalcaneal bursa.
The Retrocalcaneal bursitis is often linked to high impact forms of sports and activities that impose repetitive stress on the back of the heel such as running, figure skating and ice hockey. Haglund deformity or subtalar joint malalignment are also anatomical factors that predispose people even more. The disorder usually accompanies the presence of insertional Achilles tendinopathy, Haglund syndrome, and other Achilles-related disorders, especially in athletes or people having chronic overuse.
Retrocalcaneal bursitis is characterized by the onset of pain at the back of the heel, which increases with the activity (running, jumping, or sitting down). The patients can complain of rigidity, particularly in the morning or following a time of immobility. Tenderness, pitting, just in front of the Achilles tendon, and slight erythema can be noticed. The condition may be acute in certain instances when there has been an acute onset of activity or direct impact on the posterior heel but in the majority of the cases, it is a chronic and progressive onset condition. The ankle causes pain that tends to restrict activities that involve ankle dorsiflexion and can affect performance in sports.
Insertional Achilles Tendinopathy
Haglund Syndrome
Sever’s Disease (Calcaneal Apophysitis)
Calcaneal Stress Fracture
Posterior Ankle Impingement Syndrome
Subcutaneous Calcaneal Bursitis
Retrocalcaneal Infection or Septic Bursitis
Most patients respond well to conservative management, including rest, activity modification, local ice therapy, oral anti-inflammatory medications, Achilles tendon stretching, and appropriate footwear or heel lifts to reduce pressure. When patients have persistent or refractory symptoms, surgical procedures (retrocalcaneal bursectomy, excision of a Haglund deformity, and repair of related insertional Achilles tendinopathy) have the potential to offer a beneficial effect.
Sports Medicine
Environmental and activity modifications play an important role in the management and prevention of retrocalcaneal bursitis. Adjustments include selecting proper footwear with a cushioned heel, adequate heel counter flexibility, and appropriate sizing to reduce posterior heel pressure. Use of heel lifts or orthotic inserts can help decrease strain on the Achilles tendon and bursa. Modifying training surfaces to softer or more forgiving terrain, reducing high-impact activities, and gradually increasing training intensity can also minimize repetitive stress. In sports settings, ensuring well-fitted protective gear such as skates or boots that do not compress the posterior heel is crucial in preventing exacerbation. Environmental and equipment changes, combined with activity modification, support conservative management and reduce recurrence risk.
Ketoprofen
Ketoprofen is applied in the treatment of mild to moderate pain and inflammation. Small initial dosages are suggested particularly in children, elderly patients, or those patients with renal or liver impairment. The therapeutic effect is not increased at doses above 75 mg. They should be administered in high doses but with close observation of the reaction of the patient.
Naproxen (Aleve, Anaprox, Anaprox DS)
Naproxen is indicated for mild to moderate pain and functions by inhibiting cyclooxygenase activity, which reduces prostaglandin synthesis and thereby decreases inflammation and pain.
Topical NSAIDs deliver a high concentration of anti-inflammatory medication directly to a localized area of pain, minimizing systemic exposure.
Diclofenac Topical (Flector Transdermal Patch, Licart, Pennsaid Topical Solution)
Diclofenac inhibits inflammatory reactions and reduces pain by decreasing prostaglandin synthesis. It is commonly used for localized musculoskeletal pain, including conditions like retrocalcaneal bursitis.
Management of retrocalcaneal bursitis typically follows a phased approach. The acute phase focuses on pain relief and reduction of inflammation through rest, ice therapy, nonsteroidal anti-inflammatory medications, and temporary activity modification. The subacute or rehabilitation phase emphasizes stretching and strengthening of the Achilles tendon, correction of biomechanical abnormalities, and gradual return to activity with appropriate footwear and orthotic support. The chronic or refractory phase involves more advanced interventions for patients who do not respond to conservative measures, including surgical options such as retrocalcaneal bursectomy, excision of a Haglund deformity, or treatment of associated insertional Achilles tendinopathy. Each phase is tailored to symptom severity, activity level, and underlying anatomical factors, with the goal of restoring function and preventing recurrence.
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