Please, note that two bursae lie near the calcaneal 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).
Patients present with posterior ankle pain made worse by passive dorsiflexion of the ankle with swelling/erythema in the region of the distal calcaneal tendon 3,4.
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.
Causes includes 2,5:
- calcaneal tendon injury: rupture or tendinitis
- inflammatory arthropathies: Reiter syndrome, ankylosing spondylitis, rheumatoid arthritis
- calcaneal fractures
- infectious bursitis
- prominence of the posterosuperior calcaneum is frequently seen 1
- decreased lucency of the retrocalcaneal soft tissue (Kager triangle)
- bursa distension by a hypoechoic fluid collection: >1 mm anteroposteriorly, >7 mm craniocaudally, or >11 mm transversely is considered abnormal 4
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.
- 1. van Dijk CN, van Sterkenburg MN, Wiegerinck JI et-al. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19 (5): 835-41. doi:10.1007/s00167-010-1374-z - Free text at pubmed - Pubmed citation
- 2. Hirji Z, Hunjun JS, Choudur HN. Imaging of the bursae. J Clin Imaging Sci. 2011;1 (1): 22. doi:10.4103/2156-7514.80374 - Free text at pubmed - Pubmed citation
- 3. Banks AS, Downey MS, Martin DE et-al. McGlamry's comprehensive textbook of foot and ankle surgery. Lippincott Williams & Wilkins. ISBN:0683304712. Read it at Google Books - Find it at Amazon
- 4. Bottger BA, Schweitzer ME, El-Noueam KI et-al. MR imaging of the normal and abnormal retrocalcaneal bursae. AJR Am J Roentgenol. 1998;170 (5): 1239-41. doi:10.2214/ajr.170.5.9574592 - Pubmed citation
- 5. Narváez JA, Narváez J, Ortega R et-al. Painful heel: MR imaging findings. Radiographics. 2000;20 (2): 333-52. doi:10.1148/radiographics.20.2.g00mc09333 - Pubmed citation