The retrocalcaneal bursa is a deep bursa lying between the posterior superior surface of the calcaneus and the anterior surface of the Achilles tendon, just proximal to the tendon's calcaneal insertion. It cushions the Achilles tendon against the sharp posterior superior calcaneal angle during ankle dorsiflexion.
Retrocalcaneal bursitis produces posterior heel pain that is worse with dorsiflexion and palpable on deep compression between the Achilles tendon and the calcaneus. It is distinguished from superficial Achilles bursitis (between skin and tendon) by its deeper location. Haglund's deformity (prominent posterior superior calcaneal prominence) predisposes to retrocalcaneal bursitis. Ultrasound demonstrates the fluid-filled bursa anterior to the Achilles tendon. Treatment includes heel lifts, physical therapy, and ultrasound-guided steroid injection (avoiding the Achilles tendon itself). Endoscopic retrocalcaneal bursectomy with or without Haglund resection is definitive for refractory cases.
Posterior heel pain deep to the Achilles tendon from bony impingement — often associated with Haglund's deformity and managed with heel lifts, footwear modification, and injection before considering surgical bursectomy.
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