What is bursitis of the heel? 

At the rear of the heel bone, there are two small friction-reducing structures called bursae (calcaneus).

  1. The retrocalcaneal bursa is a fluid-filled sac that rests between the Achilles tendon and the heel bone, minimising friction during repeated movement.
  2. Between the Achilles tendon and the skin is the subcutaneous calcaneal bursa, which reduces friction once more.

These bursae can become irritated and inflamed if they are put under excessive stress owing to a rapid shift in activity levels, starting a new sport, wearing shoes that do not fit properly, or a direct impact (a shopping cart hitting the back of your heel). Systemic inflammatory diseases like rheumatoid arthritis can also induce heel bursitis. A bursitis occurs when a bursa becomes irritated and causes significant pain.

What are the symptoms of bursitis of the heel?
The following are the signs and symptoms of heel bursitis:

  • Swelling or redness on the back of the calcaneus.
  • Walking and exercising cause pain.
  • When you rest your weight directly through your heel, such as when driving, you may experience pain.
  • Pain when wearing shoes (particularly if they are tight or too small) (especially if they are tight or too small).
  • Stretching your calf causes pain.
  • Over the rear of calcaneus, there is pain.

What other conditions can present as heel bursitis?

Other conditions that can manifest itself in the same way as a heel bursitis include:

  • Achilles tendonitis in the mid-portion
  • Plantar fasciitis 

Heel bursitis vs Insertional achilles tendinopathy?

The insertion of the Achilles tendon and the bursae of the heel are inextricably linked. The Achilles tendon connects the rear of the heel bone to the Achilles tendon. The subcutaneous calcaneal bursa is located directly beneath the skin, superficial to the Achilles insertion, while the retrocalcaneal bursa is located between the Achilles tendon and the heel bone. Bursitis and insertional Achilles tendinopathy can both be caused by the same thing (for example, quickly increasing your activity levels or changing sport). It’s not uncommon for insertional Achilles tendinopathy and bursitis to develop at the same time. This is especially true if you have rheumatoid arthritis or another inflammatory condition. In contrast to an insertional Achilles tendinopathy, which normally does not swell or cause night discomfort, a bursitis may also manifest with swelling at the heel and pain throughout the night.

Heel bursitis and insertional Achilles tendinopathy can affect anyone at any age and are not gender specific. Both disorders are frequent among athletes as well as sedentary people who begin a new fitness routine or sport.

Clinically, distinguishing between a bursitis and an insertional Achilles tendinopathy is challenging. An ultrasound scan is essential to check the quality of the Achilles tendon and the health of the bursae in order to achieve a precise diagnosis.

Retrocalcaneal bursitis and pre-achilles tendon
What exactly is bursitis?

A bursa is a possible space between two anatomical components, such as a bone and a tendon. Bursae function as a tiny cushion that helps promote friction-free mobility between adjacent components by reducing compression.

The subcutaneous bursa is placed superficial to the Achilles tendon, while the retro-calcaneal bursa is located deeper in the bursa (see images below). Between the epidermis and the Achilles tendon is the subcutaneous bursa. Between the Achilles tendon and the calcaneum is the retro-calcaneal bursa (heel bone).


Excessive friction and compression might cause either bursa to become inflamed. Bursitis is a condition that occurs as a result of overuse or unusual activity. For example, increasing your walking distance too soon or wearing new shoes when training for a marathon. The bursa is a highly sensitive tissue that, when inflamed, can be quite painful.

Shape of heel bone
Some persons are more prone to bursitis because of the shape of their calcaneal (heel) bone. If you have a bony spur or a Haglund’s deformity, you should see a doctor right away. When an extra piece of bone grows from the heel bone, it’s called a bony spur. A Haglund’s deformity is a bony protrusion in front of the Achilles tendon on the heel bone. Both can put pressure on the bursa and generate friction. One of the most prevalent reasons that insertional Achilles tendon problems do not resolve is heel bursitis, especially if your discomfort is specifically localised on the back of the heel bone.

Why do people get heel bursitis?

An increase in mechanical stress on the bursa causes retrocalcaneal bursitis (Buda et al, 2013).
This can be caused by a number of factors, including:

  • If you start a new form of exercise, e.g. you start running
  • If you boost your training too rapidly, you’ll burn out.
  • If it’s your first time wearing a new pair of shoes,
  • You’re wearing shoes that aren’t the right size for you. Excessive pressure between the heel and the back of the shoe can result as a result of this.
  • A shopping cart crashing into you or someone kicking you in the back of the heel

How is bursitis diagnosed?

Bursitis of the heel, both retro-calcaneal (deep) and subcutaneous (superficial), is diagnosed with a clinical examination and an ultrasound scan of the heel. The bursa and its surrounding components, such as the Achilles tendon, Kager’s fat pad, and the heel bone, are visualised with a diagnostic ultrasound scan. An MRI scan does not show these structures as clearly as diagnostic ultrasonography does.

Before considering an injection for heel pain, Joint Injections performs a diagnostic ultrasonography (at no additional charge). If the scan indicates a bursitis, this is a viable target for an injection. A diagnostic ultrasound scan can also identify whether you have a bony spur or a Haglund’s deformity, both of which can cause bursitis.

Is a steroid injection effective for bursitis?
A retro-calcaneal or subcutaneous bursitis is an inflammation of the bursa. A steroid injection, also known as a corticosteroid injection, is a powerful anti-inflammatory that can significantly reduce the pain and swelling associated with bursitis. This gives you a pain-free window of opportunity to continue your rehabilitation and return to sport or exercise.

Bursitis is frequently associated with Achilles tendon problems and should always be investigated if Achilles symptoms do not improve.

The injection is only one part of a successful bursitis treatment approach. Before or after the injection, here are some helpful hints to assist you reduce pain and regain full function:

  • Wear trainers with a heel raise and stability control. Shoes with flat soles, such as Converse Allstars or ballet pumps, will increase your problems.
  • Wearing slip-on leather shoes or any shoes that are excessively tight around the heel and rub on the back of the heel is not a good idea.
  • Consult a physiotherapist to begin an ankle and foot strengthening programme. This will very certainly include a calf-strengthening programme.
  • Ice the region for 15 minutes twice a day. To avoid burning your skin, wrap the ice in a tea towel. Ice burns are extremely painful and can leave a permanent scar on the skin (just like burns from heat).

What injection is effective for bursitis?

Steroid injections are used in the vast majority of bursitis injections around the heel. We have a lot of expertise treating bursitis with steroids in a variety of patients, from professional runners to sedentary people. A steroid injection is an excellent therapy option if you have a painful, swollen, and inflamed bursa that has been confirmed by ultrasound.

Bursitis is a difficult ailment to cure, and conservative treatment and physiotherapy may not always work. A steroid injection can give you the boost you need to keep on with your rehabilitation. To make the process as painless as possible, the steroid is coupled with a local anaesthetic. At Joint Injections, all injections are performed under ultrasound guidance to ensure that the needle is inserted in the proper location for maximum pain relief.

For bursitis, we occasionally employ hyaluronic acid or sclerosant injections, but steroid injections are the most usual. Please do not hesitate to contact us if you have any questions about these alternatives.

How many injections do you need?
For retro-calcaneal or subcutaneous bursitis, a patient will rarely require more than one injection. In most cases, a single injection is sufficient to offer pain relief. The number of steroid injections around tendons, particularly the Achilles tendon, must be minimised.

At Joint Injections, all injections are done with care and as part of a comprehensive treatment plan.

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all foot and ankle disorders. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.