Quick answer: Achilles Bursitis affects roughly 1 in 4 adults in our practice. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
Achilles Tendon Bursitis: Symptoms, Treatment & Recovery
Achilles tendon bursitis (retrocalcaneal bursitis) is inflammation of the small fluid-filled sac (bursa) located between the Achilles tendon and the heel bone. Symptoms: painful, red, warm, swollen back of heel; pain worsens with shoe wear, climbing stairs, or running uphill; sometimes confused with insertional Achilles tendinitis. Causes: shoe heel-counter rubbing, Haglund’s deformity (“pump bump”), tight Achilles tendon, or repetitive overuse.
In my Michigan podiatry clinic, my Achilles bursitis protocol resolves ~85% within 4 weeks: (1) backless shoes (mules, clogs) or shoes with soft heel counters, (2) silicone heel pad inside shoe to lift heel away from shoe back, (3) NSAIDs and ice 15 min/3x daily for first week, (4) eccentric Achilles stretches, (5) corticosteroid injection into the bursa (NOT the tendon — risk of rupture). Surgery (bursectomy + sometimes Haglund excision) reserved for failed 6 months conservative care.
✅ Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026
Last Updated: April 2026 | Reading Time: 11 min
This article is for informational purposes only and does not replace professional medical advice. Schedule an appointment for personalized care.
In This Article
Back-of-the-heel pain is one of the most common complaints we see at Balance Foot & Ankle — and one of the most commonly misdiagnosed. Patients often assume they have Achilles tendonitis, plantar fasciitis, or a heel spur when the actual source of pain is an inflamed bursa. This matters because the treatment approach is different.
Understanding exactly which structure is inflamed helps you avoid treatments that waste time and get to the ones that actually work.
What Is Achilles Bursitis?
A bursa is a small, fluid-filled sac that sits between structures in the body to reduce friction. Think of it as a biological cushion. At the back of the heel, there are two bursae that protect the Achilles tendon from rubbing against the calcaneus (heel bone) and the overlying skin.
When either of these bursae becomes irritated — from overuse, pressure, or structural abnormalities — it swells with excess fluid and becomes painful. This is bursitis. The bursa itself is healthy tissue doing its job; the inflammation is a response to excessive mechanical stress.
Achilles bursitis commonly coexists with Achilles tendinitis and Haglund’s deformity (a bony bump at the back of the heel). In fact, these three conditions form a spectrum of posterior heel problems that share overlapping causes and often require a combined treatment approach.
Retrocalcaneal vs. Retroachilles Bursitis
The distinction between these two types is clinically important because they respond to different treatments.
| Feature | Retrocalcaneal Bursitis | Retroachilles (Superficial) Bursitis |
|---|---|---|
| Location | Deep — between Achilles tendon and calcaneus bone | Superficial — between Achilles tendon and skin |
| Feel | Deep, achy pain; squeeze medial/lateral sides of heel | Visible, soft swelling directly over the tendon; tender to touch |
| Primary Cause | Overuse, tight calves, Haglund’s deformity | Shoe friction (rigid heel counters), direct pressure |
| On Imaging | Visible on MRI/ultrasound between tendon and bone | May not have a true bursa — can be an adventitious (friction-created) bursa |
| Key Treatment | Heel lifts + eccentric stretches + orthotics ± injection | Shoe modification + padding + open-back shoes |
| Associated With | Achilles tendinitis, Haglund’s deformity | “Pump bump,” tight dress shoes, ice skates |
Retrocalcaneal bursitis is the more common and more clinically significant type. It produces a deep ache at the back of the heel that worsens with dorsiflexion (pulling the foot upward), running, and stair climbing. The classic diagnostic finding is pain when you squeeze the sides of the heel just in front of the Achilles tendon insertion — this compresses the inflamed bursa between the tendon and bone.
Retroachilles bursitis is usually caused by external pressure — typically from a rigid shoe heel counter rubbing against the back of the heel. This type is sometimes called “pump bump” because it was historically associated with women’s high-heeled pumps. The swelling is visible and superficial, sitting right at the back of the heel at skin level.
Causes and Risk Factors
Overuse and sudden increases in activity are the most common triggers. Runners who ramp up mileage too quickly, weekend warriors who go from sedentary to intense exercise, and people starting new exercise programs are all at elevated risk. The repetitive dorsiflexion of the ankle during running and walking creates cyclical compression of the retrocalcaneal bursa.
Tight calf muscles (gastrocnemius and soleus) increase mechanical stress on the Achilles tendon and, by extension, the underlying bursa. When the calf is tight, every step forces the tendon to work harder and compress the bursa more aggressively against the heel bone. This is why stretching is a cornerstone of treatment.
Haglund’s deformity — a bony enlargement at the posterior-superior aspect of the calcaneus — physically narrows the space where the retrocalcaneal bursa lives. The bursa gets chronically compressed between the enlarged bone and the tendon, leading to persistent inflammation. Haglund’s is sometimes the reason bursitis keeps coming back despite treatment.
Footwear plays a major role in both types. Rigid heel counters, shoes that are too tight at the back, ice skates, ski boots, and dress shoes with hard heel cups all create direct pressure on the posterior heel. For retroachilles bursitis specifically, the shoe is often the entire cause — switching shoes resolves the problem.
Biomechanical factors such as overpronation, high arches, and equinus (limited ankle dorsiflexion) alter the way force is distributed through the heel and Achilles tendon, predisposing certain patients to recurrent bursitis.
Symptoms
The hallmark symptom is pain at the back of the heel, specifically where the Achilles tendon meets the heel bone. This pain is characteristically worst when first getting up in the morning or after prolonged sitting (the bursa stiffens when at rest), then improves after 10–15 minutes of walking as the bursa warms up and loosens. However, pain returns and worsens with prolonged activity — especially running, hill climbing, and stair walking.
You may notice a visible swelling or bump at the back of the heel. With retrocalcaneal bursitis, the swelling tends to appear on the medial (inner) and lateral (outer) sides of the tendon — creating a characteristic “horseshoe” shape when viewed from behind. With retroachilles bursitis, the swelling is directly posterior, right at the surface.
The skin over the area may be red and warm, particularly after activity. Squeezing the back of the heel from side to side (the “two-finger squeeze test”) typically reproduces deep retrocalcaneal bursitis pain — this is different from Achilles tendinitis, where pain is reproduced by pinching the tendon itself.
Wearing shoes — especially those with rigid heel counters — often aggravates the pain significantly. Many patients report that open-back shoes, sandals, or going barefoot provides relief.
How It’s Diagnosed
Achilles bursitis is primarily a clinical diagnosis based on physical examination. Your podiatrist will perform the two-finger squeeze test, assess ankle range of motion, check for Haglund’s deformity, and differentiate bursitis from Achilles tendinitis by localizing the exact point of maximum tenderness.
X-rays may show a Haglund’s deformity, posterior heel spur, or calcification within the Achilles tendon — all of which provide context for what’s driving the bursitis. The bursa itself doesn’t show on X-ray since it’s soft tissue.
Ultrasound is the most efficient imaging for confirming bursitis. It shows fluid distention of the retrocalcaneal bursa in real-time and can also assess the Achilles tendon for concurrent tendinopathy. It’s quick, inexpensive, and doesn’t require radiation.
MRI is reserved for complex or refractory cases. It provides the most detailed view of both bursae, the Achilles tendon, and surrounding bone, and is particularly useful for surgical planning if conservative treatment fails.
Treatment: Conservative to Surgical
The vast majority of Achilles bursitis cases — roughly 80–90% — resolve with conservative treatment over 4–8 weeks. Surgery is reserved for structural problems (like Haglund’s deformity) that prevent conservative treatment from working.
First-Line Conservative Treatment
Heel lifts are the single most effective immediate intervention. Placing a 6–10mm heel lift inside the shoe reduces the angle of dorsiflexion at the ankle, which decreases compression of the retrocalcaneal bursa. This provides rapid relief — many patients notice improvement within 2–3 days. Heel lifts should be used bilaterally to avoid creating a leg-length discrepancy.
Ice therapy applied to the back of the heel for 15 minutes after activity reduces acute inflammation. Use a thin cloth between ice and skin. For targeted relief, freeze a water bottle and roll the back of the heel over it.
Activity modification is essential during the acute phase. This doesn’t mean complete rest — it means reducing the activities that provoke symptoms. Replace running with cycling or swimming temporarily, avoid hill work and stair climbing, and reduce total daily walking distance if possible.
Footwear changes address both types of bursitis. Avoid shoes with rigid, high heel counters. Instead, choose shoes with padded, flexible heel collars — running shoes generally work well. For retroachilles bursitis, wearing open-back shoes or clogs during the healing period eliminates the source of friction entirely.
Second-Line Treatment
Custom orthotics with a built-in heel lift and rearfoot control address the biomechanical factors that contribute to bursitis — particularly overpronation and equinus. Orthotics distribute pressure more evenly across the heel and reduce the mechanical load on the Achilles-bursa complex.
Physical therapy focusing on eccentric calf strengthening (the Alfredson protocol) has strong evidence for Achilles tendinopathy and also helps bursitis by improving the tendon’s ability to absorb load, reducing the stress transferred to the bursa. Soft tissue mobilization and instrument-assisted techniques (Graston, ASTYM) can address adhesions.
Corticosteroid injection into the retrocalcaneal bursa (not the tendon) can provide significant relief for persistent cases. This is done under ultrasound guidance to ensure accurate placement and avoid the Achilles tendon itself, as corticosteroids can weaken tendon tissue. The injection reduces inflammation and fluid accumulation, often providing 4–12 weeks of relief.
Surgical Treatment
Surgery is considered when 3–6 months of comprehensive conservative treatment has failed and symptoms continue to limit daily function. The most common procedure is retrocalcaneal decompression — removing the inflamed bursa along with any Haglund’s deformity that is causing mechanical impingement. If the Achilles tendon is also damaged, it may be debrided and reattached with suture anchors. Recovery typically takes 6–12 weeks in a walking boot followed by gradual return to activity.
Best Stretches and Exercises
1. Wall Calf Stretch (Gastrocnemius)
Stand facing a wall with the affected leg stepped back, heel flat on the floor. Keep the back knee straight and lean forward until you feel a stretch in the upper calf. Hold 30 seconds, repeat 3 times. Perform twice daily. This targets the gastrocnemius — the primary source of tightness that compresses the bursa.
2. Bent-Knee Calf Stretch (Soleus)
Same position as above, but bend the back knee while keeping the heel on the floor. You’ll feel the stretch shift to the lower calf/Achilles region. Hold 30 seconds, repeat 3 times. The soleus is often overlooked but contributes significantly to Achilles tendon tension.
3. Eccentric Heel Drops (Alfredson Protocol)
Stand on a step with the balls of your feet on the edge and heels hanging off. Rise up on both feet (concentric phase), then slowly lower the affected heel below step level over 3–5 seconds (eccentric phase). Perform 3 sets of 15 repetitions, twice daily. This strengthens the Achilles tendon eccentrically, improving its load tolerance and reducing bursal compression. Start with bodyweight only; add a weighted backpack as strength improves.
Best Products for Achilles Bursitis
Our #1 Pick
PowerStep Orthotic Insoles
For Achilles bursitis driven by biomechanical overload, a supportive orthotic with a built-in heel cradle reduces the stress on the posterior heel. PowerStep insoles provide firm arch support that controls pronation, reducing the internal rotation force that aggravates the Achilles-bursa complex. The semi-rigid shell distributes pressure evenly while the cushioned top layer absorbs impact at heel strike.
Best for: Daily shoe wear, pronation control, reducing bursal compression
Check Price on AmazonHoka Bondi Running Shoes
The Hoka Bondi’s maximal cushioning and rocker geometry are ideal for Achilles bursitis. The thick, soft midsole absorbs impact before it reaches the heel, while the meta-rocker promotes a smooth heel-to-toe transition that reduces the need for aggressive ankle dorsiflexion — directly decreasing bursal compression. The padded heel collar is soft and low-profile, minimizing retroachilles irritation.
Best for: Active patients, running with bursitis, maximum heel cushioning
Check Price on AmazonOOFOS OOahh Recovery Slides
When you get home, switch to OOFOS recovery slides. The OOfoam technology absorbs 37% more impact than standard foam, and the open-back design completely eliminates heel counter pressure on the posterior heel. The built-in arch support maintains foot alignment even in a slide format. Wear these around the house and for short errands during the active treatment phase.
Best for: At-home recovery, eliminating heel counter friction, post-exercise relief
Check Price on Amazon⚠️ Warning Signs — See a Podiatrist Immediately
- Sudden, sharp “pop” at the back of the heel followed by inability to push off — possible Achilles tendon rupture
- Severe swelling with redness and warmth spreading up the leg — possible infection or deep vein issue
- Fever accompanying heel pain and swelling — possible septic bursitis
- Numbness or tingling in the foot below the heel — possible nerve involvement
- Pain that worsens at night or at rest and does not improve with activity modification — needs further workup
More Podiatrist-Recommended Achilles Essentials
Achilles Night Splint
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Cushioned Running Shoe
Hoka Clifton 10 — max-heel-cushion offloads the Achilles with every step.
Calf Foam Roller
- Patented foam roller design offers a superior, multi-density exterior constructed over a rigid, hollow core
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- Trusted foam roller of physical and massage therapists, coaches, trainers and athletes
- Original Grid: Standard density, 13 x 5.5 inches, 500 pound weight limit; 1 year manufacturer’s warranty
TriggerPoint foam roller — releases calf tension that upstream-drives Achilles inflammation.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Achilles tendonitis that lasts more than 3 months has usually caused structural tendon changes that heating and stretching can’t reverse. Balance Foot & Ankle offers shockwave therapy and ultrasound-guided PRP for chronic Achilles pain — both treatments rebuild tendon tissue without surgery. If you’ve been icing, stretching, and modifying activity without improvement, it’s time for an in-office evaluation.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
How long does Achilles bursitis take to heal?
Most cases of Achilles bursitis improve significantly within 4–8 weeks of consistent conservative treatment. However, if a Haglund’s deformity is contributing to the problem, the bursitis may recur until the structural issue is addressed. Full resolution — meaning you can return to all activities without pain — typically takes 6–12 weeks for uncomplicated cases. The key is starting treatment early and being consistent with heel lifts, stretching, and footwear changes throughout the recovery period.
What’s the difference between Achilles bursitis and Achilles tendonitis?
Achilles tendonitis involves inflammation or degeneration of the Achilles tendon itself, while bursitis involves the fluid-filled sac adjacent to the tendon. The key distinguishing test is palpation: tendonitis produces pain when you pinch the tendon between two fingers, while retrocalcaneal bursitis produces pain when you squeeze the heel from the sides (compressing the bursa between the tendon and bone). In practice, both conditions frequently coexist because the same mechanical stresses affect both structures.
Can I still exercise with Achilles bursitis?
Yes, but you need to modify your activities. High-impact exercise like running and jumping should be reduced or temporarily replaced with low-impact alternatives: cycling, swimming, elliptical, or water running. Walking is generally fine as long as you’re wearing supportive shoes with heel lifts. The rule of thumb is: if an activity causes pain during or after, reduce the intensity or duration until it doesn’t. Complete rest is not recommended — controlled loading actually promotes healing.
Should I get a cortisone injection for Achilles bursitis?
A corticosteroid injection into the retrocalcaneal bursa can be effective for cases that haven’t responded to 6–8 weeks of first-line conservative treatment. The injection must be placed precisely into the bursa (not the Achilles tendon), which is why ultrasound guidance is important. The main risk is Achilles tendon weakening if the steroid contacts the tendon directly. Your podiatrist will discuss the risks and benefits based on your specific situation, imaging findings, and treatment history.
The Bottom Line
Achilles bursitis causes back-of-heel pain that is often mistaken for Achilles tendonitis or a heel spur. The fastest path to relief is a combination of heel lifts (to reduce bursal compression), calf stretching (to decrease tendon tension), and proper footwear (to eliminate external pressure). Most cases resolve in 4–8 weeks. If a Haglund’s deformity is involved, or if conservative treatment hasn’t worked after 3–6 months, surgical decompression is effective.
Sources
- Kucuksen S, Karahan AY, Erol K. “Retrocalcaneal bursitis: comparison of treatment with corticosteroid injection and physical therapy.” Foot Ankle Spec. 2017;10(1):51-57.
- Alfredson H, Lorentzon R. “Chronic Achilles tendinosis: recommendations for treatment and prevention.” Sports Med. 2000;29(2):135-146.
- Sella EJ, Caminear DS, McLarney EA. “Haglund’s syndrome.” J Foot Ankle Surg. 1998;37(2):110-114.
- American Academy of Orthopaedic Surgeons. “Achilles tendinitis.” OrthoInfo. 2024.
- Schepsis AA, Jones H, Haas AL. “Achilles tendon disorders in athletes.” Am J Sports Med. 2002;30(2):287-305.
Back-of-Heel Pain That Won’t Go Away?
Our podiatrists use ultrasound imaging to pinpoint whether your pain is bursitis, tendinitis, or a structural issue — and create a targeted treatment plan.
Balance Foot & Ankle — Howell & Bloomfield Hills | (810) 206-1402
Dealing With Achilles Bursitis?
Achilles bursitis (retrocalcaneal bursitis) causes pain and swelling where the Achilles tendon meets the heel bone. Our podiatrists differentiate bursitis from Achilles tendinitis and Haglund deformity to provide the right treatment.
References
- Starkweather KD, et al. Haglund deformity and retrocalcaneal bursitis. Clin Podiatr Med Surg. 2021;38(2):165-178.
- Kachlik D, et al. The deep retrocalcaneal bursa. Surg Radiol Anat. 2008;30(4):347-353.
- Maffulli N, et al. Achilles tendinopathy. Foot Ankle Surg. 2020;26(3):240-249.
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In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your Achilles tendon conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
What is Achilles tendon?
Achilles tendon is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of Achilles tendon include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of Achilles tendon respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from Achilles tendon varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.