A bursa is a sac of synovial fluid, rich in protein and collagen, that lies between a tendon and a bone to help the tendon glide smoothly over the bone. There are 2 bursae that surround the Achilles tendon to protect it from friction. The retrocalcaneal bursa lies between the tendon and the back, or posterior surface, of the heel bone (calcaneus). This is a "true" bursa that is present from birth. It acts as a cushion between these two structures to protect the tendon from friction against the heel bone.
The larger subcutaneous calcaneal bursa lies overtop of the tendon at the lower part of the heel where the tendon joins to the heel bone. This bursa develops as you age, an "adventitious" bursa, to protect the tendon from friction at the back of the heel.
Bursitis occurs when a bursa is irritated from frequent pressure and it becomes inflamed. When one or both of these bursa become inflamed it is generally referred to as Achilles bursitis because of the bursa's proximity to the Achilles tendon. In some cases, an inflamed bursa can become infected with bacteria (referred to as septic bursitis) and it is necessary to see a doctor to get rid of the infection.
Due to the proximity to the area on the Achilles tendon, Achilles bursitis is often mistaken for tendinitis. Achilles bursitis is a common overuse injury in runners, ice skaters and other athletes.
Symptoms of Achilles Bursitis
When you suffer from Achilles bursitis it will be most noticeable when you begin an activity after rest:
- Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa.
- Direct pressure on the bursa will exacerbate the pain and should be avoided if possible.
- Tenderness and swelling which might make it difficult to wear certain shoes on the feet.
- As the bursa becomes more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a "pump bump", and is usually red, and extremely tender. Swelling can cause difficulties moving as the range of motion in the ankle can be affected.
- Limping due to the pain may occur
- If you press on both sides of the inflamed heel, there may be a firm spongy feeling.
- Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads.
- Possibly a fever if you are suffering from septic bursitis (You will need to see a doctor for medication to get rid of the infection).
- For individuals who wear high-heeled shoes frequently, they may also feel an increase in pain when they are wearing flat shoes. When wearing high-heels, the calf muscles and Achilles tendon remain in a shortened position. When flat shoes are worn it causes the calf muscles and Achilles tendon to stretch more than usual causing the tendon to tighten around the heel bone causing irritation.
Achilles Bursitis Causes
- Tight shoes or shoes that do not fit properly can cause extra pressure on the back of the heel.
- Athletes overtraining or runners increasing their distance to quickly.
- Haglund deformity, a bony enlargement on the back of the heel bone, during dorsiflexion causes an impingement of the bursa between the Achilles tendon and the heel bone.
Relieving the symptoms of bursitis initially focuses on taking the pressure off the bursa. This can be done with proper cushioning, inserts, or footwear but may require surgery if it is a bone formation problem (i.e. Haglund's Deformity). If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and perscribe antibiotics to treat the infection.
For non-infectious bursitis, the preliminary treatment starts with conservative treatment options (click to view). Surgery to remove the inflamed bursa is normally not required for bursitis, however if you fail to see improvement with the conservative treatments, your physician may recommend surgery to remove the bursa completely. Although this removes the problem of an inflamed bursa, you are left with less cushioning in your joint which can lead to other conditions such as fraying of the tendons, muscles or ligaments in the treated area. Eventually, fraying can lead to increasing weakness and rupture in severe cases.
Other Conservative Treatment Methods can be Risky
Alternative medications like cortisone injections are NOT advised for any type of Achilles Tendon condition. This is because there is increased risk of rupture of the tendon following a cortisone injection.
"Medical evidence shows that cortisone shots can damage the surrounding tissue, fray the Achilles tendon, and even trigger a rupture. Most side effects are temporary, but skin weakening (atrophy) and lightening of the skin (depigmentation) can be permanent." (reference: American Academy of Orthopaedic Surgeons)
The most important factor in healing bursitis is resting your ankle. This can be difficult when you have to carry on with daily activities, but resting and elevating your foot whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that stress your bursa until your pain and inflammation settle.
Treatments should involve decreasing swelling, relieving pain and stress on the ankle, correcting any biomechanical dysfunction (over-pronation or flat feet) and then restoring strength and movement in your ankle. If you are performing an activity that could cause further trauma to the bursa, it is recommended that you protect the area with padding and/or proper footwear to prevent further irritation or damage.
Cold Compression Therapy
For years, doctors, trainers, and other medical professionals have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.
Cold Compression works by stopping and slowing nerve and cell function in the injured area and reducing swelling that can block blood vessels. This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood through the tissue and tissue cells begin to break-down. Without cold compression therapy cellular break-down and tissue damage continues as the cells do not get the oxygen they need to survive. By limiting the amount of damage done to your Achilles Tendon, you also limit the amount of healing that needs to occur.
Cooling the bursa as needed throughout the day, for approximately 15 - 20 minutes at a time, is recommended. Applying cold is the first step in treating your bursitis.
The T•Shellz Wrap®
Once the inflammation of your bursitis has been reduced with an ice pack or cold compress, it is time to help the body boost its healing process through use of the Achilles TShellz Wrap. It is through the blood the body carries the nutrients, oxygen, and antibodies the injured tissues need to repair and rebuild. It is well known that increased blood flow helps your body accelerate the healing process.
Unfortunately, when you are suffering from bursitis in your retrocalcaneal bursa and/or subcutaneous calcaneal bursa it is painful to walk and move your foot normally. When you limit movement in your foot the blood flow is reduced, starving your tissue of the necessary oxygen and nutrients. The trick is to find a way to increase blood flow without causing pain and/or further inflaming the bursae. This is where the T•Shellz Wrap® comes in, helping improve the elasticity of the achilles tendon as well as surrounding soft tissue. Further to this, your injury area will receive a magnified increase in blood flow which will flush toxins that always build up around a soft tissue injury and introduce more nutrients (its in the blood!) to damaged cells so they can heal at a highly accelerated rate. We guarantee that this will get your bursae and/or Achilles tendon back to normal fast.
This is why the T•Shellz Wrap® is such an important tool. The whole purpose of the wrap is to accelerate blood flow to soft tissue in the treatment area. The end result; you relax the blood vessels within soft tissues of the treatment area. The vessels will naturally expand and allow for more blood flow to reach the very tissues you are trying to heal. In addition, this process will help clear the area of toxins and excess fluid build up, thereby reducing inflammation.
Blood Circulation Boost compliments your body's natural healing process by promoting the flow of blood to your foot while you give it the rest it needs.
T•Shellz Wraps® contain a unique, flexible Carbon Fiber Energy Pad which is flexible and will shape to conform to your body. This Energy Pad emits a uniform wave of perfectly safe energy over its entire surface. This energy is absorbed by soft tissue in your achilles and lower leg, opening blood vessels, resulting in an increase in blood flow. Increased blood circulation is what your body needs to accelerate the healing of soft tissue and this is why we recommend the T•Shellz Wrap®.
With dedication, the right tools, and the right information - you will achieve your goal of a sustainable recovery. A combination approach of cold, deep heat, and functional movements will make it happen much more quickly.
In our experience, soft tissue repair rates via conservative home treatment methods using a dedicated, comprehensive approach have surprised many of our clients, but will differ from person to person. In nearly all cases, however, it is very important to stop whatever you were doing that created the injury in the first place (ie. running, jumping, climbing stairs).
During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your Achilles tendon until your pain and inflammation settle. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!
Learn More About Achilles Injuries & Treatments
I want to learn more about Achilles Surgery & Post-Surgery Recovery
I want to learn more about Blood Circulation Boost
I want to learn more about Ice & Heat: Which Is Better For The Achilles?
I want to learn more about Stretching for the Achilles