Understanding Heel Pain: Plantar Fasciitis and Retrocalcaneal Bursitis

Heel pain is a common condition that can interfere with daily activities, making walking or standing uncomfortable. Two of the most frequent causes of heel pain are plantar fasciitis and retrocalcaneal bursitis. Understanding their causes, symptoms, and treatment options can help manage the pain and improve mobility.

 

Plantar Fasciitis

Plantar fasciitis is the inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot and connects the heel bone to the toes. This condition is one of the most common causes of heel pain, particularly among runners, people who are overweight, and those who wear unsupportive footwear.

 

Causes of Plantar Fasciitis

• Excessive strain on the plantar fascia due to prolonged standing or running.
• Wearing shoes with poor arch support or cushioning.
• Sudden increase in physical activity.
• Tight calf muscles or Achilles tendons.
• Obesity, which adds extra stress to the heel.

 

Symptoms of Plantar Fasciitis

• Sharp pain in the heel, especially in the morning or after long periods of rest.
• Pain that worsens with prolonged standing or walking.
• Tenderness along the bottom of the foot.

 

Retrocalcaneal Bursitis

Retrocalcaneal bursitis is the inflammation of the bursa, a fluid-filled sac located between the Achilles tendon and the heel bone. This condition often results from repetitive stress or excessive pressure on the heel, leading to pain and swelling.

 

Causes of Retrocalcaneal Bursitis

• Overuse from activities like running, jumping, or excessive walking.
• Wearing tight or stiff shoes that press against the heel.
• Direct trauma or repeated friction on the back of the heel.
• Tight Achilles tendon, increasing pressure on the bursa.

 

Symptoms of Retrocalcaneal Bursitis

• Pain and swelling at the back of the heel.
• Increased discomfort when pressing on the heel or wearing shoes.
• Stiffness and aching in the heel, especially after activity.

 

Diagnosis of Heel Pain

A healthcare provider will diagnose plantar fasciitis or retrocalcaneal bursitis based on a physical examination and medical history. They may check for tenderness, swelling, or mobility issues. In some cases, imaging tests like X-rays or MRIs may be recommended to rule out fractures or other conditions.

 

Treatment Options for Heel Pain

Most cases of plantar fasciitis and retrocalcaneal bursitis can be managed with conservative treatments, including:

 

Home Remedies and Lifestyle Modifications

• Rest and activity modification: Reducing activities that put excessive stress on the heel.
• Stretching exercises: Regular stretching of the plantar fascia, calf muscles, and Achilles tendon can relieve tension.
• Ice therapy: Applying ice packs to reduce inflammation and pain.
• Supportive footwear: Wearing shoes with proper arch support and cushioning to absorb shock.
• Orthotic inserts: Custom or over-the-counter insoles to provide extra support and alignment.

 

Medical Treatments

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen can help reduce pain and swelling.
• Physical therapy: Targeted exercises and techniques to improve foot strength and flexibility.
• Corticosteroid injections: In severe cases, doctors may recommend injections to reduce inflammation.
• Night splints: Wearing splints that keep the foot stretched overnight can relieve morning pain.

 

Surgical Options

Surgery is rarely needed but may be considered for chronic cases unresponsive to other treatments. Procedures include:

• Plantar fascia release: A surgical procedure that partially cuts the plantar fascia to relieve tension.
• Bursectomy: Removal of the inflamed bursa in severe retrocalcaneal bursitis cases.

 

Prevention of Heel Pain

• Maintain a healthy weight to reduce pressure on the feet.
• Wear supportive and properly fitted shoes.
• Stretch regularly to keep foot and calf muscles flexible.
• Avoid excessive running or standing without proper rest periods.

 

When to See a Doctor

If heel pain persists for several weeks despite home treatments, worsens over time, or interferes with daily activities, it’s important to seek medical advice. Early intervention can prevent further complications and ensure a quicker recovery.

By understanding the causes and treatment options for plantar fasciitis and retrocalcaneal bursitis, individuals can take proactive steps to relieve heel pain and improve their overall foot health.