Achilles Bursitis

Achilles Bursitis

Achilles Bursitis: Also known as Achilles tendon bursitis, retro-Achilles bursitis, pre-Achilles bursitis and tendo-Achilles bursitis.

Signs & Symptoms Of Achilles Tendon Bursitis:

  • Back of the heel pain upon waking or after rest.
  • This usually lasts for about 15-20 minutes.
  • Moving around and light stretching make it feel better.
  • A soft tissue bump forming at the back of the heel.
  • Icing and massage make it feel better.
  • History of achilles tendon overuse.
  • This may include heavy running.
  • History of tight shoes at the heel.


What Is Achilles Tendon Bursitis?

  • There are two “gel” sacks in the heel, the pre-Achilles and the retro-Achilles bursa.
  • Both pre-Achilles bursitis and retro-Achilles bursitis are possible.


Achilles Bursitis
There are two types of achilles tendon bursitis: Retro-Achilles Bursitis (retrocalcaneal bursa) and Pre-Achilles Bursitis (subcutaneous calcaneal bursa).


Tendo-Achilles Bursitis Causes:

  • Irritation and inflammation are the most common causes of Achilles tendon bursitis.
  • The most common cause of this inflammation is Achilles tendinitis.
  • Tendinitis is inflammation of the Achilles tendon.
  • It is very common for Achilles tendinitis and bursitis to occur together; if the bursa is irritated, then the tendon will be irritated as well!
  • It is also very common for the back of the heel to rub against the shoes.
  • If you have a low quality or bad heel counter on your shoe, it can compress your heel.


Who Is At Risk For Tendo-Achilles Bursitis:

  • Overuse of the Achilles tendon or calf.
  • This overuse causes Achilles tendinitis which may lead to further bursitis.
  • Repetitive irritation of the back of the heel.
  • This can be due tight or improperly fitting shoes.
  • More rarely it can be associated with: gout, rheumatoid arthritis and other autoimmune conditions.
Tendo-Achilles Bursitis
A common cause of Achilles or ankle bursitis is tight fitting shoes. Irritation against the back of your heel may lead to inflammation, which leads to bursitis.


Pre-Achilles Bursitis:

  • Pre-achilles bursitis is inflammation of the bursa most superficial to the skin.
  • The pre-Achilles bursa is between the skin and the Achilles Tendon.
  • This is the more visible skin Achilles tendon bursitis.
Pre-Achilles Bursitis
Pre-Achilles bursitis is the more visible bursa between the skin and the Achilles tendon.

Retro-Achilles Bursitis:

  • Retro-Achilles bursitis is inflammation between the Achilles tendon and the calcaneus.
  • This is the more common and more painful Achilles tendon bursitis.
Retro-Achilles Bursitis
Retro-Achilles bursitis is the deeper and more frequent cause of back heel pain. This is the bursa between the Achilles tendon and the calcaneus.


Achilles Bursitis Treatment:

  • Treatment is based on decreasing inflammation.
  • Then identify and prevent the cause of inflammation.
  • Then make sure it doesn’t come back.
  • Don’t worry, this can all be done from home.


1) Relieve The Inflammation:

  • The pain is usually worst after rest or sleeping.
  • This is because the inflammatory cells have settled in that area with decreased blood flow.
  • If you ice, massage, apply heat or gently stretch it will feel better.
  • It usually takes about 15-20 minutes to feel better.
  • Even just walking around will get your blood flowing!


A) Walk Around & Gently Stretch:

  • When you get up in the morning massage it out a bit.
  • I like to stretch my calf muscles and Achilles tendon while brushing teeth!
  • No matter what you do, it will get better in a little while.


B)Ice The Back Of The Heel:

  • Do this 2-3x a day for 1-2 weeks.
  • It takes this long for the inflammation to die down.
  • Icing 2-3x per day for about 15-20 minutes will decrease the flow of inflammatory cells into the muscle.
  • Afterwards the arteries will vasodilate further flushing out inflammatory cells from the region.
  • Ice has deeper penetrating power than heat.
  • But you can use heat as well.
  • Just don’t use heat if you recently injured an area.


C) Anti-Inflammatory Medication:

  • This can be a topical gel by prescription.
  • It can also be oral pills like Ibuprofen or Aspirin.
  • Do not take these unless instructed to do so by your physician or podiatrist.
  • Take a 1-2 week course to attempt to decrease the inflammation and speed up your healing time.
  • Take 2-3x doses per day as instructed, this builds up anti-inflammatory enzyme levels in your system.
  • Taking just 1-2 pills and then stopping does nothing for inflammation!


D) Stop Inflammation For 1-2 Weeks:

  • It can take up to 1-2 weeks for the inflammation to go down.
  • For some mild cases this may only be 1-2 days.
  • For more severe cases it could be 2 weeks +.
  • Just keep icing, massaging and stretching.
  • If it isn’t getting better after about 2 weeks, see your podiatrist!


2) Achilles Tendon Stretching:

Achilles Tendon Bursitis Treatment
Studies show that if you do not get 10 degrees of dorsiflexion from the floor, your achilles tendon will be under stress! Stretching is the key to keep the pain away!
  • Once the pain starts to decrease, you will be able to stretch.
  • Focus on stretching your hamstrings, calf and plantar fascia.
Ankle Bursitis Stretches
It doesn’t matter what stretches you prefer, but just make sure to do it for a couple minutes every day! That is the most important thing!
  • Pick one exercise for the hamstring, one for the calf and one for the plantar fascia.
  • All stretches should be for 15-30 seconds until tightness (not pain).
  • Do these 2-3x per day.
  • The entire stretching session should take less than 5 minutes per day.



3) Get Some Achilles Tendon Support:

  • Make sure you don’t fall into the bad habits that caused this pain.
  • Get good rigid shoes with heel support.
  • Measure your shoes properly.
  • Get a good over the counter pair of orthotics.


A) Achilles Tendon Supporting Shoes:

  • Get a good running shoe.
  • Make sure it has a stiff base.
  • May sure it is not too flexible.
  • Make sure there is enough room for your big toe and pinky toes.
  • The heel counter should be rigid.
  • The average running shoe should be worn less than 400 miles or so.
  • This is about 3-6 months, don’t keep a shoe for years!
  • I’m as frugal as it gets, but you can get a good new shoe for $35 on sale.
  • Don’t risk your future mobility!


Achilles Tendon Bursitis Shoes
There are many amazing running shoe companies out there. You don’t need to spend $100+ on a shoe, get some coupons online and get it for $50 or less, but don’t wear them into the ground!


B) Correctly Size The Shoes:

  • Fit your shoes in the evening.
  • Your feet are the most swollen at night.
  • Use a Brannock device to measure your size properly.
  • Measure your foot length.
  • Measure your arch length.
  • Measure your foot width length.
Calcaneal Bursitis Treatment
Make sure your shoe fits properly. This is achieved through a Brannock device!

C) Get A Good Orthotic:

  • Most people have been burned by poor orthotic purchases.
  • Don’t by a crummy gel cushion, that is only for a poorly cushioned heel (fat pad atrophy).
  • Gel pads only mask the pain temporarily, they do not fix it!
  • The Dr. Scholl’s machines work well, but the orthotic can be 60$ or so.
  • Consider something like a powerstep ordered online (20-30$ range).
  • If you have insurance, get a custom orthotic made, these are the best if available.
Calcaneus bursitis
A rigid orthotic will work wonders in your life! You will be able to stand hours longer and walk miles further. I personally never go anywhere without mine!

If That Didn’t Cure You:

Check Out Our Back Of The Heel Pain Guide:

Back Of The Heel Diagnosis Guide!