Ankle

Achilles Tendon Bursitis

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Achilles Tendon Bursitis, Achilles Bursitis, Superficial Calcaneal Bursitis, Pump-Bump, Retrocalcaneal Bursitis

  • Epidemiology
  1. Middle aged and older adults (esp. 40 to 60 years old)
  2. More common in women
  • Predisposing factors
  1. Overuse injury in athletes
  2. Low cut shoes
  • Anatomy
  1. General
    1. Two bursae located near achilles tendon insertion
  2. Superficial Calcaneal Bursa (Pump-Bump)
    1. Located over achilles tendon
    2. Irritated by constant rubbing by shoe
    3. Associated with thin heel pad
  3. Retrocalcaneal bursa
    1. Located under achilles tendon
    2. Irritated by Calcaneus
      1. Prominent posterosuperior angle (Haglund's Disease)
  • Symptoms
  1. Heel Pain with swelling and erythema
  2. Pain exacerbating factors
    1. Worse at the beginning of activity (e.g. walking)
    2. Wearing shoes may worsen pain
  3. Painful limp may develop
  • Signs
  1. Inflammation at achilles tendon insertion on Calcaneus
  2. Two finger Squeeze Test
    1. Patient with plantar flexed ankle
    2. Examiner compresses tissue that is immediately anterior to the distal achilles tendon
    3. Positive if compression causes pain
  3. Images
    1. ankleAchillesBursa.jpg
  • Differential Diagnosis
  1. See Heel Pain
  • Imaging
  1. Indicated only in refractory cases
  2. XRay: Haglund's Deformity
    1. Bone spur on superior Calcaneus
    2. Calcified distal achilles tendon
  3. Ultrasound
    1. Hyperemia in bursa region (increased Blood Flow on color doppler)
    2. Hypoechogenic fluid in retrocalcaneal bursa
  • Management
  1. General Measures
    1. Heel pads
    2. NSAIDs
    3. Alternate Ice Therapy with heat therapy
    4. Consider wearing sandals (open back)
    5. Elevation of shoe heel with soft cushion
  2. Corticosteroid Injection are not recommended
    1. Offer only short-term pain relief (ineffective in 14% of patients)
    2. Exercise caution with local steroid injections (and use Ultrasound guidance if performed)
    3. Risk of Achilles Tendon Rupture or weakening in the first 6 months after injection
  3. Surgery for refractory cases
    1. Bursa and bony prominence resection
    2. Symptom and function improvement by 4 months is typical
  • References
  1. Mazzone (2002) Am Fam Physician 65(9):1805-10 [PubMed]
  2. Van Wyngarden (1997) Am Fam Physician 55(6):2207-12 [PubMed]
  3. Morancie (2025) Am Fam Physician 112(6): 648-56 [PubMed]