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Overview<br>Retrocalcaneal Bursitis. This bursa is located at the back of the heel. Bursitis in this area is often associated with conditions such as ankylosing spondylitis or rheumatoid arthritis. It can occur in healthy individuals who wear improperly fitted shoes. Symptoms include painful swelling that develops at the back of the heel. Calcaneal Bursitis. This bursa is located at the sole or bottom of the heel. Inflammation usually produces pain in the heel when standing. Causes include [http://barbaroehl.wordpress.com/2015/03/28/heel-aches-the-causes-signals-and-therapy-options heel spurs], excess weight, injury, and wearing improperly fitted shoes.<br><br>Causes<br>The most common cause of bursitis is repeated physical activity, but it can flare up for no known reason. It can also be caused by trauma, rheumatoid arthritis, gout, and acute or chronic infection.<br><br>Symptoms<br>Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down.<br><br>Diagnosis<br>Diagnosis of heel bursitis can be made by your health practitioner and is based on the following. Assessing the location of the pain by palpating the back of the heel. Assessment of any inflammation at the back of the heel. Assessment of biomechanics and foot function. Ultrasound or MRI can reveal inflammation of the retro calcaneal bursa.<br><br>Non Surgical Treatment<br>One of the most effective treatments for infracalcaneal bursitis is to temporarily avoid weight-bearing activities that put stress or strain on your heel bone. PRICE (protection, rest, hot/cold contrast compresses, compression, and elevation) is another good acute management technique for this foot problem. Changing your footwear is an effective long-term prevention and treatment tool for infracalcaneal bursitis. Footwear that possess a flat support base, a sufficiently wide toe box to accommodate natural toe splay, and a flexible sole are best for preventing and managing infracalcaneal bursitis. An integrated approach to this problem usually involves the use of padded socks that help reduce pressure, friction, and inflammation in your affected area. Natural anti-inflammatory agents can also be helpful in quelling inflammation, reducing pain, and improving treatment times for infracalcaneal bursitis. In rare cases, more aggressive treatment methods may be required, such as cortisone injections or surgery to drain the bursal sac.<br><br>Surgical Treatment<br>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.