Do you also experience pain in the back of your heel after standing for a long time, running, or suddenly starting to exercise? Does it sometimes feel a little swollen? Many people ignore this pain, thinking, "It will go away on its own." But this can actually be a symptom of a condition called 'Heel Bursitis.' So today, let's talk about it in detail, what it is, why it occurs, and how we can treat it.
What exactly is Heel Bursitis?
Simply put, Heel Bursitis is an inflammation of a bursa in your heel. Now you're probably wondering, "What is a bursa?"
Imagine that there are places in our body where bones, muscles, tendons, etc. come into contact with each other, right? To prevent these from rubbing against each other and causing damage, there is a small, gel-like fluid-filled sac between them. Just like putting grease on a machine, this reduces friction between those two parts and helps them move smoothly. That little sac is called a 'bursa'.
There are several bursae near your heel bone (Calcaneus). If one of these bursae is subjected to pressure or pressure for any reason, it becomes swollen, red, and painful. This is what we call bursitis. When this occurs in the heel, we call it Heel Bursitis.
There are two main types of Heel Bursitis:
There are two main types of heel spurs, depending on where they occur.
1. Retrocalcaneal bursitis: This is the most common type. It occurs when the bursa between your heel bone and the Achilles tendon, the largest tendon in the back of your leg, becomes inflamed. It is also called Achilles tendon bursitis.
2. Subcutaneous calcaneal bursitis: This type is caused by swelling of the bursa between the Achilles tendon and the skin over it.
The pain and discomfort caused by both types are very similar.
What are the symptoms of this condition?
If you have Heel Bursitis, you may experience one or more of the following symptoms. Let's look at these in a table.
| Symptom | A Simple Explanation |
|---|---|
| Pain and swelling | Severe pain and swelling in or behind the heel. The pain may be worse when you first get up in the morning. |
| Tenderness | The painful area hurts when you touch it with your hand or press on it. You can feel the pain even when your shoe hits it. |
| Difficulty standing on toes | Pain increases when standing on your toes. |
| Feeling warm | The area around the heel may feel warmer than other areas when touched. This is a sign of swelling. |
| Skin discoloration | Sometimes the skin in the swollen area may turn red. |
Why do we get Heel Bursitis?
There are several reasons for this. The main reason is continuous pressure on the bursa in the heel.
| Cause | How it Affects You |
|---|---|
| Overuse | Standing for long periods of time, walking long distances, running, and jumping can all put continuous pressure on the heels. |
| Sudden increase in activity | This condition can be caused by things like suddenly starting to run after not doing any exercise, or suddenly increasing your exercise at the gym. |
| Unsuitable shoes | Wearing tight shoes that pinch the back of the heel is a major cause. This can cause the bursa to become continuously irritated and swollen. |
| Not warming up properly | This may also be due to not properly warming up before any exercise or sport. |
| A bacterial infection | This is a rare occurrence. Bacteria can enter the bursa through something like a heel injury and infect it. |
Who is most at risk of developing this condition?
In addition to the above reasons, people with certain medical conditions are also at higher risk of developing Heel Bursitis.
- Haglund's deformity: This is a condition in which an extra bone spur develops on the back of the heel bone. This spur can rub against the shoe and press on the bursa.
- Rheumatoid arthritis
- Ankylosing spondylitis (AS)
- Psoriatic arthritis
- Gout
When you have joint-related diseases like this, there is a greater tendency for various joints and bursae in the body to swell.
How do you find this, Doctor?
When you go to see a doctor for heel pain, he will first listen carefully to your symptoms and then perform a physical examination.
Questions to ask you first
- Do you stand for a long time? What kind of job do you do?
- What kind of exercises and sports do you engage in?
- What kind of shoes do you usually wear?
- Has this pain happened before?
Next physical examination
- I'm checking to see if there's any swelling in your heel.
- They press down on the exact areas of pain with their hands.
- The range of motion of your foot and ankle is checked.
- You are asked to stand on your toes and bend your foot up and down to see if the pain increases.
The most important thing is to tell your doctor about your pain, how it started, and how often it increases, without hiding anything. That information will help a lot in making an accurate diagnosis.
If you suspect a bacterial infection...
If you have heel pain along with symptoms like fever and chills, your doctor may suspect a bacterial infection. If so,
- Your body temperature is being checked.
- Sometimes, a small amount of fluid can be taken from the inflamed bursa with a small needle (syringe) (bursal aspiration) and sent to be tested for bacteria.
What tests are done to confirm?
Most of the time, this condition can be diagnosed with a physical exam. However, in some cases, your doctor may recommend several tests to determine if there is another cause for the pain.
- X-ray: This can check for changes in the shape of the heel bone, conditions such as Haglund's deformity, or fractures.
- MRI scan: This can clearly show swelling in the bursa, any damage to the Achilles tendon (Achilles tendinitis), and the condition of the surrounding soft tissues.
- Ultrasound scan: This can also help to better assess the condition of the bursa and surrounding tendons.
What are the treatments for Heel Bursitis?
The best part is that this condition can often be treated without surgery. Treatment options can be divided into two categories.
Things you can do at home (RICE method)
- Rest: Stop any activity that causes or increases pain. Stop walking, running, or jumping for a while and give your leg a rest. This will give the swollen bursa time to heal.
- Ice: Place some ice cubes in a plastic bag, wrap it in a thin towel, and apply it to the painful area for about 15-20 minutes three to four times a day. This will greatly reduce pain and swelling.
- Proper Footwear: Avoid wearing tight, tight shoes altogether. Wear soft, well-fitting shoes that don't pinch the back of the heel.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can help reduce pain and swelling. However, remember, you should always consult your doctor before using any medication.
Treatment recommended by the doctor
If home treatments do not help, your doctor may recommend treatments like this.
- Orthotics: These are special devices that are placed inside shoes. Things like heel wedges help correct the way your foot strikes the ground while you walk, reducing pressure on your heel.
- Physical therapy: This is very important. A physical therapist will teach you stretching exercises for your Achilles tendon and the muscles that support your knee. These exercises will reduce the pressure on the bursa and help relieve the pain.
- Antibiotics: If your bursitis is caused by a bacterial infection, your doctor will prescribe oral antibiotics.
- Bursa injections: This is a very rare procedure. If the pain and swelling do not subside, your doctor may inject a steroid into the bursa.
- Surgery: This is the last resort. If there is no improvement after 6-12 months of treatment, a surgical procedure called a bursectomy may be necessary to remove the damaged bursa.
How long will it take for this condition to heal?
With proper diagnosis and treatment, this condition is nothing to be afraid of. Most people recover within two to three weeks with home treatment. For those with a more severe condition, it may take several months to fully recover. The most important thing is to be patient and follow your doctor's instructions.
How to prevent recurrence?
- Be sure to warm up well before exercising.
- Wear the right shoes for your activity. Avoid tight, tight shoes.
- If you run or walk, avoid hard surfaces (concrete) as much as possible and exercise on soft surfaces like grass .
- Do hamstring and Achilles tendon stretching exercises daily.
Heel Bursitis is a common condition among athletes, active people, and those who stand for long periods of time. Although it can be a bit of a pain, with the right treatment, you can get back to your normal life quickly.
Take-Home Message
- Don't ignore the pain and swelling in the back of your heel, thinking "it will go away in a little while."
- The main causes of this are overuse, wearing ill-fitting shoes, or suddenly increasing the amount of exercise.
- In the early stages, rest, ice application, and wearing the right shoes can provide great relief.
- If the pain does not subside in a few days, or if it gets worse, definitely see a doctor.
- This condition can be completely cured with proper treatment and physical therapy exercises.
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