From the Guidelines
For mild retrocalcaneal bursitis, I recommend starting with conservative treatment including rest, ice application, and non-steroidal anti-inflammatory drugs (NSAIDs) as the initial management approach. The treatment options should focus on reducing pressure on the area and alleviating symptoms. According to 1, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated).
Some key considerations for managing mild retrocalcaneal bursitis include:
- Wearing open-backed shoes or using heel lifts to reduce pressure on the affected area
- Using NSAIDs for pain management, as suggested by 1
- Decreasing activity to avoid exacerbating the condition
- Performing stretching exercises to help alleviate tension in the Achilles tendon
- Considering weight loss if the patient is overweight, as this can help reduce pressure on the heel
It's essential to note that local injections of corticosteroids are not recommended as an initial treatment 1. If symptoms persist or worsen, further evaluation and consideration of other treatment options, such as immobilization or referral to a specialist, may be necessary 1.
In terms of specific management strategies, gentle stretching exercises for the Achilles tendon can be beneficial, and physical therapy may be considered for persistent cases. However, the primary focus should be on conservative management and alleviating symptoms to prevent chronic pain and functional limitations.
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. 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 treatment for a small amount of fluid in the Kager's fat pad-retrocalcaneal bursa suggesting mild retrocalcaneal bursitis may involve 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 of Retrocalcaneal Bursitis
- The treatment of retrocalcaneal bursitis involves the reduction of inflammation and pain in the affected area.
- A small amount of fluid in the Kager's fat pad-retrocalcaneal bursa may suggest mild retrocalcaneal bursitis, as seen in studies 3, 4.
- The use of image-guided corticosteroid injections has been shown to be effective in reducing pain and inflammation in patients with retrocalcaneal bursitis, with significant short-term decreases in pain scores observed in the majority of patients 5, 6.
Anatomy and Function of Kager's Fat Pad
- Kager's fat pad is a mass of adipose tissue that occupies Kager's triangle and has three regions closely related to the sides of the triangle 3.
- The calcaneal wedge of Kager's fat pad moves into the bursa during plantarflexion and is retracted during dorsiflexion, allowing for a more caudal insertion of the Achilles tendon into the calcaneus 3, 4.
- The movement of the fat pad in and out of the bursa during ankle motion helps to reduce the risk of tendon kinking and may be implicated in heel pain syndromes 3.
Imaging and Diagnostic Techniques
- Ultrasound and magnetic resonance imaging (MRI) can be used to evaluate the retrocalcaneal bursa and surrounding structures, including Kager's fat pad and the Achilles tendon 3, 5, 4.
- The use of fluoroscopic guidance for retrocalcaneal bursa injections has been shown to be effective, with high technical success rates and significant decreases in patient pain scores 6.