A small bursa sometimes develops posterior to the subtalar joint between the posterior calcaneal surface and the overlying soft tissues. It is distinct from the retrocalcaneal bursa (between the Achilles tendon and the calcaneus) and the subcutaneous calcaneal bursa (between the Achilles tendon and skin), occupying a deeper posterior position near the posterior subtalar joint capsule.
Posterior subtalar bursitis contributes to posterior heel pain and must be distinguished from the more common retrocalcaneal bursitis, Achilles tendinopathy, and subtalar arthritis. Ultrasound and MRI identify fluid in this specific location. Intraarticular subtalar steroid injection can occasionally opacify this bursa if it communicates with the joint. Surgical excision is a last resort when conservative management fails.
Deep posterior heel pain related to subtalar joint loading, often associated with hindfoot valgus or post-traumatic subtalar arthrosis, treated with orthotics for hindfoot alignment correction, and injection or excision for persistent cases.
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