One of our patients is a young man named Albert. He is in his 30s, and an avid golfer. Saturdays, Sundays and Wednesday evenings find him on the local golf course. Lately, you’ll recognize him by the limp. Albert came to see us because his foot was « killing him, » he said. Albert explained that he had pain in the heel of his left foot. He was actually dressed for a golf game when he came to the clinic, so we were able to check out his new golf shoes. He bragged that he’d bought them on sale, for a great price. And even though they did not fit perfectly and were kind of stiff, he said, he thought they looked professional.
We thanked him for wearing his cleats in the office. It’s not everyday, we told him, that a patient arrives wearing a clue. After we examined Albert’s foot and asked him some questions about the symptoms, we gave him the diagnosis. Retrocalcaneal bursitis.
The retrocalcaneal bursa is a sac at the back of the heel that acts as a shock absorber. This little fluid-little bag cushions, lubricates and protects the tendons, bones and ligaments where they come in contact with each other. When the bursa itself becomes irritated— from being forced into ill-fitting golf shoes, for instance— the pain is felt in the back of the foot above the heel.
Bursitis is not only caused by cheap golf shoes, of course. It can be caused by other factors, such as overuse or poor technique in running or walking.
Haglund deformity— also called the pump bump because it’s associated with wearing high heels— is bursitis in the back of the Achilles tendon.
Another type of bursitis is called calcaneal bursitis. This is inflammation in the heel itself. It can be caused by a bone spur, by excess body weight, injury, or— again— by wearing poorly-fitting shoes.
Retrocalcaneal bursitis produces pain in the back of the foot above the heel.
Calcaneal bursitis produces pain in the heel itself.
We can distinguish between the various possibilities with a physical exam.
If your feet are aching, call one of our clinics (in DeSoto, Sunnyvale and Dallas) and make sure you wear your golf shoes. (Just kidding!)
Bursitis Is No Joke
If you feel pain while you’re walking, we know it’s not funny. Our first mission is to relieve the inflammation and irritation that’s causing the pain. There are medications that help, called NSAIDs (Nonsteroidal Anti-Inflammatory Medications).
Orthotic shoes are made to support the foot and prevent irritation. Gel pads can be inserted into the shoe to protect the bursa. Some patients are candidates for injections that dull the pain and reduce inflammation.
When you come to the clinic, we may take x-rays to rule out a fracture. In some cases, the bursitis is visible as a hard or red lump in the affected area.
Because many cases develop gradually, unlike Albert’s experience with the new golf shoes, the patient may be inclined to shrug it off or attribute it to aging. While aging is a factor in causing some cases of bursitis, that doesn’t mean it’s inevitable. Any chronic pain in your foot should prompt a call to our clinic.
Preventing a Recurrence
While bursitis typically affects only one foot, the fact that it’s often caused by overuse or lifestyle factors means there is a chance of recurrence. If you are a runner, make sure you run on a hard and level surface. If you wear dress shoes to work, avoid wearing high heels every day. Buy shoes that fit properly, not just stylish ones.
If you have noticed just recently some pain in your foot or ankle, try to remember if there was an event that prompted it. Don’t be shy about showing us your footwear. After all, it worked for Albert.