II. Epidemiology

  1. Middle aged and older adults

III. Predisposing factors

  1. Overuse injury in athletes
  2. Low cut shoes

IV. Anatomy

  1. General
    1. Two bursae located near achilles tendon insertion
  2. Superficial Calcaneal Bursa (Pump-Bump)
    1. Located over achilles tendon
    2. Irritated by constant rubbing by shoe
    3. Associated with thin heel pad
  3. Retrocalcaneal bursa
    1. Located under achilles tendon
    2. Irritated by Calcaneus
      1. Prominent posterosuperior angle (Haglund's Disease)

V. Symptoms

  1. Heel Pain with swelling and erythema
  2. Pain exacerbating factors
    1. Worse at the beginning of activity (e.g. walking)
    2. Wearing shoes may worsen pain
  3. Painful limp may develop

VI. Signs

  1. Inflammation at achilles tendon insertion on Calcaneus
  2. Images
    1. ankleAchillesBursa.jpg

VII. Differential Diagnosis

  1. See Heel Pain

VIII. Imaging

  1. Indicated only in refractory cases
  2. Haglund's Deformity
    1. Bone spur on superior Calcaneus
    2. Calcified distal achilles tendon

IX. Management

  1. General Measures
    1. Heel pads
    2. NSAIDs
    3. Alternate Ice Therapy with heat therapy
    4. Consider wearing sandals (open back)
    5. Elevation of shoe heel with soft cushion
  2. Corticosteroid Injection not recommended
    1. Exercise caution in local steroid injections here
    2. Risk of Achilles Tendon Rupture or weakening
  3. Surgery for refractory cases
    1. Bursa and bony prominence resection

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