The retrocalcaneal bursa (subtendinous calcaneal bursa, or bursa of the calcaneal tendon) 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 posterosuperior calcaneal angle during ankle dorsiflexion. It is distinguished from the subcutaneous calcaneal bursa, which lies behind the tendon under the skin.
| Location | Between the anterior surface of the Achilles tendon and the posterosuperior surface of the calcaneus, just above the tendon's insertion |
|---|---|
| Nearby |
|
Reduces friction between the Achilles tendon and the calcaneus 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. Haglund deformity (a prominent posterosuperior calcaneal process, or pump bump) predisposes to it, and the combination of Haglund deformity, retrocalcaneal bursitis and insertional Achilles tendinopathy is called Haglund syndrome. Ultrasound demonstrates the fluid-filled bursa anterior to the Achilles tendon. Treatment includes heel lifts, open-backed footwear, physical therapy, and ultrasound-guided steroid injection (avoiding the Achilles tendon itself). Endoscopic or open bursectomy with resection of the Haglund prominence is definitive for refractory cases.
Posterior heel pain deep to the Achilles tendon from bony impingement, often associated with Haglund deformity and managed with heel lifts, footwear modification, and injection before considering surgical bursectomy.
Combination of a prominent posterosuperior calcaneus, retrocalcaneal bursitis and insertional Achilles tendinopathy causing posterior heel pain with shoe pressure, treated with heel lifts and footwear change, and calcaneal prominence resection with bursectomy in refractory cases.
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