The subtendinous calcaneal bursa, also called the retrocalcaneal bursa, lies between the anterior surface of the Achilles tendon and the posterior surface of the calcaneus, at the superior tuberosity of the calcaneus. It reduces friction as the Achilles tendon glides over the calcaneal bone during plantarflexion. The bursa is deep to the Achilles tendon and is lined by synovium, distinguishing it from the subcutaneous calcaneal bursa that lies posterior to the tendon between skin and tendon.
Note: this entry provides detail on this specific bursa structure; see also the 'retrocalcaneal-bursa' entry which covers the same anatomical structure from a clinical perspective. This entry focuses on the relationship between the bursa and Haglund deformity: a prominent superior calcaneal tuberosity (Haglund deformity or pump bump) impinges on the bursa and anterior Achilles tendon, producing insertional Achilles tendinopathy with bursitis treated by calcaneal tuberosity reduction and bursectomy.
A prominent posterosuperior calcaneal process impinges on the retrocalcaneal bursa and anterior Achilles tendon, producing combined insertional tendinopathy and bursitis, managed with heel lifts, open-backed footwear, physiotherapy, and surgical calcaneal tuberosity resection with bursectomy for refractory cases.
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