Bursae (two or more bursa) are small, fluid-filled sacs that cushion the bones, tendons and muscles surrounding your joints. They contain a lubricating fluid that reduces friction, allowing tissues
in the body to glide past each other smoothly. Imagine the bursa as a protective layer that helps keep a tendon or muscle from fraying or getting aggravated as it eases over a bone or around a
corner. Bursitis is a condition that occurs when a bursa becomes inflamed: irritated, red and filled with more fluid than normal.
Although rare, bursitis also may be caused by an infection, known as septic bursitis. This is a serious medical condition that requires antibiotics to treat the infection and prevent its spread to
other points in the body or the bloodstream. Septic bursitis may cause the back of the ankle to become red or hot. The person may also get the chills or fever and may feel sick and tired. Typically
this type of bursitis would be suspected if there has been any history of an open wound in the area, such as a blister.
Medical experts strongly recommend that you consult a doctor if you have any of the symptoms below. Disabling joint pain that prevents you from doing your daily activities. Pain that lasts for more
than two weeks. Excessive swelling, redness, bruising or a rash around the painful joint. Sharp or shooting pain, especially when you exercise or do something more strenuous. A fever. Any of the
above could be a sign of infection, a condition such as arthritis or a more serious injury such as a tendon tear that may require medical attention.
Gram stain. A lab test called a Gram stain is used to determine if certain troublesome bacteria are present. Not all bacteria can be identified with a Gram stain, however, so even if the test comes
back negative, septic bursitis cannot be completely ruled out. White blood cell count. An elevated number of white blood cells in the bursa's synovial fluid indicates an infection. Glucose levels
test. Glucose levels that are significantly lower than normal may indicate infection.
Non Surgical Treatment
Caregivers may give you special shoe inserts with a cutout around the tender area. You may also be told to wear shoes with a reinforced heel counter. This will give better heel control. You may need
other shoe inserts (wedges) to raise your heel so it does not press against the back of the shoe. You may also wear shoes that are open in the back, such as sandals that have no strap across the
heel. You may use ibuprofen (eye-bu-PROH-fen) and acetaminophen (a-seet-a-MIN-oh-fen) medicine for your pain. These may be bought over-the-counter at drug or grocery stores. Do not take ibuprofen if
you are allergic to aspirin. You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This
medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your ankle is healed and that you can return to heavy exercise. It is important to not
exercise until your caregiver says it is OK. You could make the bursitis worse if you exercise too soon. You may need surgery to remove the bursa or part of your ankle bone. Surgery is usually not
necessary unless the bursitis is very bad and does not heal with other treatments. Your caregiver may want you to go to physical (FIZ-i-kal) therapy (THER-ah-pee). Physical therapists may use
ultrasound to increase blood flow to the injured area. Caregivers may use massage to stretch the tissue and bring heat to the injury to increase blood flow. These and other treatments may help the
bursitis heal faster. Exercises to stretch your Achilles tendon and make it stronger will be started after the bursitis has healed. You may gradually increase the amount of weight you put on your
foot when caregivers say it is OK. You may be told to stop exercising if you feel any pain.
Surgery. Though rare, particularly challenging cases of retrocalcaneal bursitis might warrant a bursectomy, in which the troublesome bursa is removed from the back of the ankle. Surgery can be
effective, but operating on this boney area can cause complications, such as trouble with skin healing at the incision site. In addition to removing the bursa, a doctor may use the surgery to treat
another condition associated with the retrocalcaneal bursitis. For example, a surgeon may remove a sliver of bone from the back of the heel to alter foot mechanics and reduce future friction. Any
bone spurs located where the Achilles attaches to the heel may also be removed. Regardless of the conservative treatment that is provided, it is important to wait until all pain and swelling around
the back of the heel is gone before resuming activities. This may take several weeks. Once symptoms are gone, a patient may make a gradual return to his or her activity level before their bursitis
symptoms began. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.
Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition. Proper stretching of the Achilles tendon helps prevent injury.