Retrocalcaneal bursitis refers to inflammation of the retrocalcaneal bursa, which lies between the anteroinferior Achilles tendon and posterosuperior calcaneus. It forms part of Haglund syndrome.
Please, note that two bursae lie near the Achilles tendon insertion: the retrocalcaneal bursa (between the tendon insertion and the posterior angle of the calcaneus) and the subcutaneous calcaneal bursa (between the tendon and the skin).
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Clinical presentation
Patients present with posterior ankle pain made worse by passive dorsiflexion of the ankle with swelling/erythema in the region of the distal Achilles tendon 3,4.
Pathology
Retrocalcaneal bursitis rarely occurs in isolation and is almost always associated with calcaneal tendinitis and/or Haglund deformity. The bursa may also be primarily involved by inflammatory or infectious bursitis 4.
Etiology
Causes include 2,5:
Achilles tendon injury: rupture or tendinitis
inflammatory arthropathies: reactive arthritis, ankylosing spondylitis, rheumatoid arthritis
infectious bursitis
Radiographic features
Plain radiograph
prominence of the posterosuperior calcaneum is frequently seen 1
decreased lucency of the retrocalcaneal soft tissue (Kager triangle)
Ultrasound
bursa distension by a hypoechoic fluid collection: >1 mm anteroposteriorly, >7 mm craniocaudally, or >11 mm transversely is considered abnormal 4
MRI
Bursa distension by a fluid collection:
T1: low signal
T2: high signal
STIR: high signal
Treatment and prognosis
Most patients respond to conservative treatment (e.g. NSAIDs, heel lifts, CAM boot); steroid injections may also be of benefit but may cause tendinous rupture. Surgical treatment (excision of the bursa) is typically reserved for refractory cases.