Retrocalcaneal Bursitis

Does the back of your heel hurt when you walk uphill, climb stairs or push up onto your toes?

Perhaps you've noticed a deep, uncomfortable pain where your Achilles tendon meets your heel bone. It might feel as though something is being pinched inside your heel, particularly when you bend your ankle or take a longer stride.

You may also have noticed swelling around the sides of your Achilles tendon, or find that certain shoes make the discomfort worse.

If you've been diagnosed with retrocalcaneal bursitis, these symptoms may already be familiar. Although the affected area is relatively small, the pain can make everyday activities such as walking, gardening and exercising considerably more uncomfortable than they should be.

Understanding exactly where the inflammation is occurring and why certain movements aggravate it is an important first step towards managing the condition.

In this article, we'll explain what retrocalcaneal bursitis is, how it differs from other causes of heel pain and the treatment options available. We'll also discuss how OSMO Patch offers a drug-free, non-invasive option designed to help reduce heel bursitis swelling and associated pain.

What Is Retrocalcaneal Bursitis?

To understand retrocalcaneal bursitis, it helps to know a little about the structure of your heel.

Your Achilles tendon runs down the back of your lower leg, connecting your calf muscles to your heel bone, medically known as the calcaneus. Every time you walk, climb stairs or rise onto your toes, this tendon helps transfer force from your calf muscles to your foot.

Located between the Achilles tendon and the upper back portion of the heel bone is a small fluid-filled cushioning sac called the retrocalcaneal bursa.

Its job is to reduce friction and allow the tendon to move smoothly against the surrounding bone.

However, when this bursa becomes irritated or compressed repeatedly, it can become inflamed and painful. This is known as retrocalcaneal bursitis, sometimes called deep heel bursitis, Achilles tendon bursitis or anterior Achilles bursitis. [1]

Unlike superficial heel bursitis, which affects tissues closer to the skin, retrocalcaneal bursitis occurs deeper inside the heel, directly between the tendon and bone.

This distinction is important because it helps explain why certain ankle movements can cause pain, even when there isn't any obvious swelling on the surface.

Why Does the Bursa Become Compressed?

The retrocalcaneal bursa sits in a relatively confined space between two firm structures: the Achilles tendon and the heel bone.

When you bend your ankle upwards, bringing your toes towards your shin, the relationship between these structures changes. This movement, known as dorsiflexion, can increase compression around the bursa.

Normally, the bursa helps the tissues move comfortably against one another. However, when it is already inflamed, repeated compression may aggravate the irritation and associated pain.

This is one reason why activities such as walking uphill, climbing stairs, deep squatting or performing certain calf stretches can become uncomfortable.

The problem isn't necessarily the amount of movement itself, but the pressure being placed on an already irritated area.

Continuing activities that repeatedly compress the inflamed bursa may prevent the irritation from settling, which is why identifying and avoiding aggravating movements is an important part of managing retrocalcaneal bursitis. [2]

What Are the Symptoms of Retrocalcaneal Bursitis?

Retrocalcaneal bursitis typically causes pain around the upper back of the heel, close to where the Achilles tendon attaches to the bone.

Because the affected bursa is relatively deep, you may not always see an obvious lump or swelling, particularly in the early stages.

Common symptoms include:

• Deep pain behind the heel: Often felt immediately in front of the Achilles tendon near its attachment to the heel bone.

• Tenderness on either side of the tendon: The area may feel sore when pressure is applied beside the Achilles tendon.

• Pain when bending the ankle upwards: Particularly during activities that compress the tissues at the back of the heel.

• Discomfort when rising onto your toes: The movement places additional demands on the Achilles tendon and surrounding structures.

• Swelling around the heel: Sometimes noticeable on either side of the tendon, particularly when the inflammation becomes more pronounced.

• Stiffness or limping: You may find yourself changing how you walk to avoid putting pressure on the painful area.

• Warmth or redness: The tissues around the affected heel may occasionally become warmer or more visibly irritated.

For some people, symptoms develop slowly over several weeks. Others may notice discomfort after a sudden increase in walking, running or another activity that places additional strain on the heel.

It's important to remember that these symptoms aren't exclusive to retrocalcaneal bursitis. An Achilles tendon injury or another heel condition may produce similar discomfort.

What Causes Retrocalcaneal Bursitis?

Retrocalcaneal bursitis commonly develops through repeated mechanical irritation, although several contributing factors may be involved.

Repeated Compression During Movement

Activities that involve frequent ankle bending or repeated loading of the Achilles tendon can increase pressure around the bursa.

Running, hill walking and climbing stairs are examples of activities that may aggravate this area, particularly when the tissues are already inflamed.

Haglund's Deformity

Some people have a prominent area of bone at the upper back of the heel, known as Haglund's deformity.

Depending on its shape and position, this bony prominence can reduce the available space around the Achilles tendon and retrocalcaneal bursa.

As the ankle moves, the surrounding tissues may become compressed or irritated against the prominent bone.

However, not everyone with Haglund's deformity develops bursitis, and having a bony prominence doesn't automatically explain every case of heel pain.

Changes in Physical Activity

Perhaps you've recently returned to walking after a break, started using hills as part of your exercise routine or increased your training intensity.

Sudden changes in physical activity can expose the heel to repeated stresses it hasn't had sufficient time to adapt to.

Footwear and Heel Pressure

Shoes with a firm heel counter may contribute to irritation around the back of the heel, particularly when a prominent heel bone or superficial bursitis is also present.

Even if footwear isn't the original cause, changing to more comfortable shoes may help reduce unnecessary pressure on the affected area.

Underlying Inflammatory Conditions

Medical conditions such as rheumatoid arthritis and gout can sometimes contribute to inflammation within the bursae.

Although repetitive mechanical irritation is a common cause, an accurate diagnosis is important when symptoms are persistent or unusual. [1][3]

How Is Retrocalcaneal Bursitis Different from Other Heel Conditions?

Pain at the back of the heel can have several possible causes, and understanding the differences can help explain why an accurate diagnosis matters.

Retrocalcaneal Bursitis

Affects the deep bursa between the Achilles tendon and heel bone. Pain is commonly associated with compression of the bursa during certain ankle movements, and tenderness may be felt beside the Achilles tendon.

Superficial Calcaneal Bursitis

Affects a bursa closer to the skin at the back of the heel. Pain is often associated with direct pressure or rubbing from footwear, and swelling may be more visible.

Insertional Achilles Tendinopathy

Affects the Achilles tendon near the point where it attaches to the heel bone. This may cause stiffness, tenderness and pain during activities that load the tendon.

Plantar Fasciitis

Usually causes pain underneath the heel rather than directly behind it. The discomfort is often particularly noticeable during the first few steps after getting out of bed.

More than one condition can be present at the same time, particularly around the Achilles tendon attachment.

If you'd like a broader explanation of bursitis affecting the back of the heel, read our Achilles Bursitis Information article.

How Is Retrocalcaneal Bursitis Diagnosed?

Because several conditions can cause pain around the Achilles tendon and heel bone, a healthcare professional will generally begin by identifying the precise location of your symptoms.

They may ask when the pain first developed, whether it worsens during particular activities and whether you've recently changed your exercise routine or footwear.

During the examination, they may assess ankle movement, look for swelling around the tendon and check for tenderness on either side of the Achilles insertion.

In many cases, your symptoms and a physical examination are sufficient to make an initial diagnosis.

However, imaging may be recommended when the diagnosis isn't clear or symptoms aren't improving.

Ultrasound: Can help identify fluid or inflammation within the retrocalcaneal bursa and assess the nearby Achilles tendon.

MRI Scan: May provide a more detailed view of the bursa, tendon and surrounding tissues when a more complex injury is suspected.

X-ray: Can help identify a prominent heel bone, Haglund's deformity or other bone-related changes.

Imaging isn't always necessary, but it can be particularly useful when retrocalcaneal bursitis and insertional Achilles tendinopathy are suspected together. [1]

What Are the Treatment Options for Retrocalcaneal Bursitis?

The main objective of treatment is to reduce irritation and pressure around the inflamed bursa, manage swelling and associated pain, and allow the affected tissues to settle.

Most uncomplicated cases can be managed without surgery. [2][3]

1. Avoid Activities That Compress the Bursa

One of the most important steps is identifying which movements are causing the irritation.

If walking uphill, climbing stairs, running or rising onto your toes consistently increases the pain, those activities should be avoided while the inflammation settles.

Continuing to exercise through pain may place further pressure on the affected bursa and prolong the discomfort.

If you wish to continue exercising, activities should be carefully tailored to avoid unnecessary stress or compression around the affected heel and ankle.

Lower-impact activities may sometimes be appropriate, provided they don't aggravate your symptoms.

2. Reduce Pressure Through Footwear Changes

A change in footwear may help reduce irritation around the Achilles tendon and heel.

Shoes with a soft heel counter and suitable cushioning are often more comfortable than rigid footwear that presses directly against the painful area.

In certain cases, a podiatrist may recommend a temporary heel lift or appropriate insole to help reduce mechanical stress around the back of the heel.

However, footwear changes should be selected according to the underlying condition, particularly if Achilles tendinopathy is also present.

3. Cold and Heat Therapy for Pain and Swelling

During the first 48–72 hours following a new injury or acute flare-up, cold therapy is generally recommended to help manage inflammation, swelling and pain. Applying a cold pack wrapped in a towel for approximately 10–20 minutes at a time may provide relief. Cold therapy can also be useful if the affected area becomes irritated again following physical activity.

Once the initial inflammation and swelling have settled, gentle heat may be more beneficial. Warmth helps increase local blood circulation, relax surrounding muscles and relieve stiffness, supporting the body's natural recovery processes.

However, heat should be avoided while the affected area remains noticeably hot, red or swollen, as it may aggravate the inflammation. Regardless of which therapy you use, it's important to avoid activities that continue to irritate or place unnecessary pressure on the affected bursa.

4. Physiotherapy and Appropriate Rehabilitation

Once the acute irritation begins settling, physiotherapy may help restore comfortable ankle movement and improve the strength of the surrounding muscles.

However, exercises must be selected carefully.

Exercises that irritate the affected bursa should be avoided, particularly movements that repeatedly compress the tissues between the Achilles tendon and heel bone.

For example, aggressive calf stretching or lowering the heel below the level of a step can place additional compression around the Achilles insertion and may aggravate symptoms.

If you wish to maintain some physical activity, your physiotherapist can help tailor an exercise program that avoids unnecessary stress while supporting a gradual return to normal movement.

5. Medication, Injections and Other Medical Treatments

Pain-relieving or anti-inflammatory medication may sometimes be recommended, depending on your medical history and the severity of your symptoms.

For persistent cases, a healthcare professional may consider a corticosteroid injection into the affected bursa.

However, this procedure requires particular care because of the close proximity of the Achilles tendon. Steroid exposure around the tendon can increase the risk of tendon weakening or rupture.

Surgery is generally reserved for selected cases that haven't responded to appropriate non-surgical treatments. Where a prominent heel bone contributes to persistent compression, surgery may sometimes address the bursa and underlying bony prominence. [1][4]

Managing Heel Swelling with OSMO Patch

If you're looking for a drug-free, non-invasive option to help manage heel bursitis swelling and associated pain, OSMO Patch offers a simple home treatment designed to work while you sleep.

Developed in Australia and trusted for over 15 years, OSMO Patch is designed to help reduce swelling and associated discomfort without the use of drugs, steroids or invasive procedures.

Simply apply the patch over the affected area before going to bed, following the supplied instructions.

OSMO Patch may be considered alongside adequate rest, appropriate footwear and avoiding activities that continue to irritate the heel.

Importantly, the underlying pressure or compression contributing to retrocalcaneal bursitis still needs to be addressed. The patch isn't intended to correct a bony prominence or repair an injured Achilles tendon.

Looking for a drug-free way to help manage swelling and associated pain from heel bursitis?

→ Discover OSMO Patch for Heel Bursitis Treatment

(ALWAYS FOLLOW THE DIRECTIONS FOR USE. Not suitable for individuals with seafood or shellfish allergies)

How Long Does Retrocalcaneal Bursitis Take to Heal?

Recovery times vary depending on how severe the inflammation is, how long the condition has been present and whether other structures, such as the Achilles tendon, are also affected.

Some cases may improve over several weeks when the activities causing compression are avoided and the affected heel is given sufficient opportunity to settle. However, longer-standing cases may require more time, particularly when repeated irritation or an underlying bony prominence continues contributing to the problem.

Using OSMO Patch alongside adequate rest and avoiding activities that irritate the affected heel may help support the recovery process. By helping to reduce swelling and associated pain, OSMO Patch is designed to provide relief while the inflamed tissues have an opportunity to settle.

Even when symptoms begin improving, it's important not to return too quickly to activities that previously aggravated the heel. If you wish to continue exercising, activities should be tailored to avoid unnecessary pressure or stress on the affected area.

 

Frequently Asked Questions About Retrocalcaneal Bursitis

Where Exactly Is Retrocalcaneal Bursitis Pain Felt?

The pain is usually felt deep at the back of the heel, close to where the Achilles tendon attaches to the heel bone.

Unlike superficial heel bursitis, which affects tissues closer to the skin, retrocalcaneal bursitis involves a deeper cushioning sac between the tendon and bone.

You may notice tenderness on either side of the Achilles tendon rather than directly on the skin at the back of your heel.

Why Does Retrocalcaneal Bursitis Hurt More When Walking Uphill?

Walking uphill generally requires greater ankle movement and places additional demands on the Achilles tendon.

As your ankle bends upwards, the inflamed retrocalcaneal bursa may become compressed between the tendon and heel bone, increasing discomfort.

Until the inflammation settles, avoiding hills or other activities that repeatedly aggravate the area may help reduce irritation.

Can Retrocalcaneal Bursitis Occur Alongside Achilles Tendonitis?

Yes. Retrocalcaneal bursitis and insertional Achilles tendinopathy can occur together because the affected structures are located very close to one another.

Both can cause posterior heel pain, stiffness and discomfort during walking or exercise.

If symptoms persist, a healthcare professional may recommend an ultrasound or MRI to determine which structures are involved.

Should I Stretch My Achilles Tendon if I Have Retrocalcaneal Bursitis?

Not necessarily.

Some stretching movements can increase compression between the Achilles tendon and heel bone, particularly when the ankle is bent upwards.

Aggressive calf stretching or dropping your heel below a step may aggravate the inflamed bursa.

Exercises should be tailored to avoid unnecessary pressure on the affected area, ideally under the guidance of a qualified physiotherapist.

Can I Still Exercise with Retrocalcaneal Bursitis?

You should avoid exercises that irritate or aggravate the affected heel.

If you wish to remain active, lower-impact activities may sometimes be appropriate, provided they don't produce pain or place unnecessary stress on the inflamed bursa.

Your healthcare professional or physiotherapist can help identify suitable activities based on your symptoms.

Can Haglund's Deformity Cause Retrocalcaneal Bursitis?

Yes. Haglund's deformity is a bony prominence at the upper back of the heel that can contribute to pressure around the Achilles tendon and retrocalcaneal bursa.

However, not everyone with Haglund's deformity develops bursitis, and not every case of retrocalcaneal bursitis involves this bony prominence.

A clinical examination and, when appropriate, imaging can help determine whether it's contributing to your symptoms.

Will Retrocalcaneal Bursitis Come Back After It Heals?

It can, particularly if the activities or mechanical factors that originally irritated the bursa remain unchanged.

Repeated heel compression, unsuitable footwear or returning too quickly to strenuous exercise may contribute to recurring symptoms.

Identifying and addressing these factors can help reduce the likelihood of further irritation.

Is Retrocalcaneal Bursitis Serious?

Most cases aren't serious and can improve with appropriate non-surgical treatment.

However, persistent heel pain should be assessed to rule out Achilles tendon injuries or other conditions.

Seek prompt medical attention if you experience sudden severe pain, difficulty walking, an inability to push off your foot, or significant redness, warmth and swelling accompanied by fever.

 

When Should You Seek Medical Attention?

If pain at the back of your heel continues despite rest and avoiding aggravating activities, consult a qualified healthcare professional.

This is particularly important if the swelling becomes more pronounced, the discomfort begins affecting everyday activities or you suspect an Achilles tendon injury.

A sudden popping sensation, severe pain or difficulty pushing off your foot may indicate an Achilles tendon rupture and requires urgent assessment.

Similarly, increasing redness, warmth or swelling accompanied by fever may indicate an infection that requires prompt medical attention.

Medical References

[1] Merck Manual Professional Edition: Anterior Achilles Tendon Bursitis (Retrocalcaneal Bursitis). Read the Merck Manual medical reference

[2] NHS – Bexley Musculoskeletal Service: Retro-calcaneal Bursitis. Read the NHS medical guidance

[3] Hospital for Special Surgery: Retrocalcaneal Bursitis. Read the medical resource

[4] American Academy of Family Physicians: Heel Pain: Diagnosis and Management. Read the published medical guidance