From the Guidelines
Treatment for retrocalcaneal bursitis should begin with conservative measures, including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated), as these methods have been shown to be effective in reducing symptoms and improving quality of life. When considering treatment options, it is essential to prioritize methods that reduce pressure on the affected area and promote healing.
- Initial treatment options may include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses to support the foot and ankle
- NSAIDs to manage pain and inflammation
- Decreased activity to allow the bursa to heal
- Stretching exercises to improve flexibility and reduce tension on the Achilles tendon
- Weight loss (if indicated) to reduce pressure on the foot and ankle As noted in the study by the American College of Foot and Ankle Surgeons 1, local injections of corticosteroids are not recommended, and immobilization may be considered in particularly acute or refractory cases.
- It is crucial to continue treatments until symptoms resolve, which can take up to six to eight weeks, and to prioritize conservative measures to minimize the risk of complications and promote optimal outcomes.
From the FDA Drug Label
Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
The treatment for retrocalcaneal bursitis may include naproxen. The recommended starting dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.
From the Research
Treatment Options for Retrocalcaneal Bursitis
- Conservative methods are often used to treat retrocalcaneal bursitis, including ice, activity modification, and nonsteroidal anti-inflammatory drugs 3
- Local corticosteroid injection may be used in the management of retrocalcaneal bursitis, but it poses a risk of Achilles tendon rupture, especially in professional and high-level athletes 4
- Image-guided retrocalcaneal bursa corticosteroid injection has been shown to be effective in reducing pain scores in the short-term, but it also carries a risk of Achilles tendon rupture 5
Surgical Intervention
- Surgical treatment is an option for chronic retrocalcaneal bursitis that does not respond to conservative treatment 6
- Endoscopic calcaneoplasty is a less invasive surgical technique that can be used to treat chronic retrocalcaneal bursitis, and it has been shown to be effective in improving pain and function 7
- Arthroscopic treatment of chronic retrocalcaneal bursitis can also be effective in improving pain and function, and it allows for the removal of the source of irritation and the repair of any damaged tissues 7
Important Considerations
- The treatment of retrocalcaneal bursitis should be individualized based on the patient's specific condition and needs 3
- The risk of Achilles tendon rupture should be carefully considered when using local corticosteroid injection or surgical intervention to treat retrocalcaneal bursitis 4, 5
- Proper diagnosis and timely response to persisting symptoms are crucial in the treatment of retrocalcaneal bursitis 7