Heel Bursitis Treatment Guide 2026 | Podiatrist

Feature	Retrocalcaneal Bursitis	Subcutaneous Calcaneal Bursitis	Achilles Tendinopathy (Insertional)
Location	Deep to Achilles, between tendon and bone	Superficial — between Achilles and skin	At Achilles insertion on calcaneus
Palpation finding	Tenderness medial and lateral to Achilles at heel	Soft squishy swelling on back of heel	Tenderness directly over Achilles at bone
Two-finger squeeze test	Positive — reproduces deep pain	Negative	Negative (different location)
Associated deformity	Haglund’s deformity (pump bump)	None typically	Calcific deposit at insertion common
Shoe trigger	Stiff heel counter (dress shoes, ski boots)	Any posterior counter friction	Tight footwear, hill running
Best imaging	MRI — fluid in retrocalcaneal space	Ultrasound — superficial fluid collection	MRI — tendon degeneration/tearing

Treatment	Mechanism	Timeline	Notes
Open-back footwear (clogs, mules)	Removes heel counter pressure from inflamed bursa	Immediate symptom relief	First-line; most important single intervention
Heel lift (1/4–1/2 inch)	Reduces Achilles tension; moves bursa away from bony contact	1–2 weeks	Bilateral to avoid pelvic tilt
NSAIDs (ibuprofen, naproxen)	Anti-inflammatory; reduces bursal fluid production	2–4 weeks	With meals; not for >6 weeks without monitoring
Physical therapy (eccentric Achilles program)	Reduces Achilles tension contributing to bursal compression	6–8 weeks	Alfredson protocol modified for insertional
Corticosteroid injection (bursa-specific)	Potent anti-inflammatory; reduces bursal inflammation	Immediate-2 weeks	MUST avoid Achilles tendon — rupture risk
Surgical bursa excision ± Haglund’s resection	Removes inflamed tissue and bony impingement	3–4 months recovery	For refractory cases; >90% satisfaction

Quick answer: Treatment for heel bursitis treatment follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.

Two Types of Heel Bursitis

Retrocalcaneal bursitis: The bursa between the Achilles tendon and the posterosuperior calcaneus becomes inflamed from compression. Common triggers: rigid shoe counters (especially dress shoes and new athletic shoes), Haglund deformity (a bony prominence on the posterosuperior heel that creates a “pump bump”), and increased training load. Pain at the Achilles insertion area, worsened by pressing the back of the shoe against the heel.

Calcaneal (subcutaneous) bursitis: Between the skin and the heel bone, typically at the posterior heel surface. Direct pressure from shoe counters in patients without Haglund deformity but with a prominent calcaneus. Treatment is almost always shoe modification.

Distinguishing from Achilles Tendinopathy

Achilles tendinopathy causes tenderness along the tendon itself, typically 2–6cm above the insertion. Retrocalcaneal bursitis is tender specifically at the insertion point and the posterosuperior calcaneal prominence. Ultrasound is excellent for distinguishing bursal fluid accumulation from tendon degeneration — I use diagnostic ultrasound in clinic for this distinction when the presentation is unclear.

Treatment Approach

First-line: Open-back shoes or soft heel counter footwear to eliminate the compression source. Heel lifts (7–10mm) reduce the angle at which the Achilles contacts the calcaneal prominence. Ice 15 minutes twice daily. NSAIDs for 7–10 days during acute flares. Corticosteroid injection into the bursal space (not the tendon) is effective for persistent cases — I use ultrasound guidance to ensure accurate bursal placement and avoid the Achilles.

For Haglund deformity causing recurrent retrocalcaneal bursitis: calcaneal osteotomy (surgical shaving of the posterosuperior calcaneal prominence) combined with bursectomy. Outcomes are very good — 85–90% patient satisfaction. Recovery involves non-weight-bearing for 4–6 weeks.

Frequently Asked Questions

How long does heel bursitis take to heal? With proper footwear modification and treatment: 4–8 weeks for most cases. Haglund deformity cases may require surgical management if conservative care fails after 3–6 months.

Can I exercise with heel bursitis? Swimming and cycling are tolerable. Running and activities with rigid heel counter footwear aggravate it. Modify activity until the acute phase resolves.

Frequently Asked Questions

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your heel condition, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.