Achilles Bursitis

Is pain at the back of your heel making walking, exercising or even wearing your usual shoes increasingly uncomfortable?

Perhaps you've noticed a tender swelling near your Achilles tendon, or a sharp pain when the back of your shoe presses against your heel. You might find that your heel feels reasonably comfortable while resting, only to become painful when walking uphill, climbing stairs or spending longer periods on your feet. Even something as simple as going for your usual morning walk can become frustrating when every step reminds you that something isn't right.

If you've been diagnosed with Achilles bursitis, you'll understand just how much this discomfort can interfere with your normal routine. The good news is that many cases improve without surgery. Understanding what's causing the irritation, which activities may be aggravating your heel and how to manage the symptoms can help you take the right steps towards recovery.

In this article, we'll look at the common causes and symptoms of Achilles bursitis, how it differs from Achilles tendonitis and the treatment options available, including how OSMO Patch offers a drug-free, non-invasive option for helping reduce heel bursitis swelling and associated pain.

What Is Achilles Bursitis?

Your Achilles tendon is the strong band of tissue connecting your calf muscles to the back of your heel bone. It plays an important role in everyday movements such as walking, running, climbing stairs and pushing up onto your toes.

Around the heel are small fluid-filled sacs called bursae, which help cushion the surrounding tissues and reduce friction as they move against each other. One of these is the retrocalcaneal bursa, located deep between the Achilles tendon and the heel bone, also known as the calcaneus.

When this bursa becomes irritated or inflamed, it can cause pain, tenderness and swelling at the back of the heel. This condition is known as retrocalcaneal bursitis, often referred to as Achilles bursitis or heel bursitis. [1]

However, there's an important distinction worth understanding. There is also a more superficial bursa located closer to the skin at the back of the heel. When this area becomes irritated, often through repeated friction from footwear, the condition is called superficial calcaneal bursitis.

Although both can cause pain behind the heel, the precise location of the inflammation can influence which activities aggravate your symptoms and which treatment options may be most appropriate. [2]

What Are the Symptoms of Achilles Bursitis?

One of the most frustrating things about Achilles bursitis is how much discomfort such a small area of inflammation can cause. You may have difficulty wearing certain shoes, walking longer distances or standing comfortably for extended periods.

Common symptoms include:

• Pain at the back of the heel: Usually felt around the area where the Achilles tendon attaches to the heel bone.

• Localised swelling: Puffiness or a noticeable swelling on either side of the Achilles tendon or behind the heel.

• Tenderness to touch: The affected area may feel particularly sensitive when pressed.

• Pain when wearing shoes: Footwear with a firm heel counter may place pressure on the irritated tissues.

• Discomfort when walking: Particularly when walking uphill, climbing stairs or pushing up onto your toes.

• Heel stiffness: A feeling of tightness around the heel and ankle, especially after resting.

• Warmth or redness: The affected area may sometimes appear red or feel warmer than the surrounding skin.

Symptoms often develop gradually rather than following one particular injury. You might initially notice mild discomfort after exercising, only to find that the pain becomes more persistent as you continue with your normal activities.

It's also worth remembering that not all pain around the Achilles tendon is caused by bursitis. Achilles tendonitis, tendon injuries and other conditions can produce similar symptoms.

What Causes Achilles Bursitis?

Achilles bursitis generally develops when repeated pressure, friction or excessive strain irritates the cushioning tissues at the back of your heel. Although runners and athletes may be more susceptible, the condition isn't limited to people who exercise regularly.

Several factors can contribute.

Repetitive Walking or Running

Walking longer distances, running or regularly exercising on hills can place additional demands on the Achilles tendon and surrounding structures. Over time, repeated movement and compression may irritate the retrocalcaneal bursa.

Poorly Fitting Footwear

Shoes with a rigid or tight heel counter can place direct pressure on the back of your heel. This is particularly relevant for superficial heel bursitis, where the affected bursa lies close to the skin. You may notice that one particular pair of shoes consistently aggravates your symptoms.

Sudden Increases in Physical Activity

Perhaps you've recently started walking longer distances, returned to running after a break or taken up a new exercise routine. Increasing your activity too quickly can place more stress on the tissues around your heel than they're accustomed to handling.

Heel Bone Shape and Haglund's Deformity

Some people have a more prominent area of bone at the upper back of the heel, known as Haglund's deformity. Depending on its shape and the surrounding tissues, this bony prominence may contribute to friction or pressure around the Achilles tendon and retrocalcaneal bursa. However, having a prominent heel bone doesn't necessarily mean you have bursitis.

Underlying Inflammatory Conditions

Certain medical conditions, including rheumatoid arthritis and gout, can sometimes contribute to inflammation around the heel. Often, several factors are involved rather than one obvious cause. [1][3]

Achilles Bursitis vs Achilles Tendonitis – What's the Difference?

Achilles bursitis and Achilles tendonitis can be easily confused because both may produce pain around the back of the heel. They can also occur together, although they affect different structures.

Achilles bursitis involves inflammation of a cushioning bursa near the heel bone, whereas Achilles tendonitis or tendinopathy involves irritation or changes within the Achilles tendon itself.

With Achilles bursitis, you may notice localised swelling and tenderness close to the heel bone, particularly when pressure is applied around the area. Achilles tendinopathy may cause pain directly within the tendon, either near its attachment to the heel or further up towards the calf.

Persistent tendon pain isn't always caused by inflammation alone, which is why healthcare professionals often use the term Achilles tendinopathy. Because these conditions can produce overlapping symptoms, obtaining an accurate diagnosis is important before deciding on treatment.

For more information about related heel and ankle conditions, visit our Heel & Ankle Pain Information page.

Why Can Achilles Bursitis Hurt More When Wearing Shoes?

For many people, one of the first signs that something isn't right is discomfort when putting on their usual shoes. You may find that your heel feels reasonably comfortable when barefoot around the house, only to become painful when you put on enclosed footwear.

The reason is relatively straightforward. The firm section at the back of a shoe can place pressure directly against the sensitive tissues around your heel. When a bursa is already irritated, repeated rubbing or compression can aggravate the inflammation and associated pain.

Simply changing your footwear may help reduce some of that irritation.

Shoes with a softer heel counter, adequate cushioning and a comfortable fit may be easier to tolerate. In some cases, an open-backed shoe may help temporarily reduce direct pressure on the affected area. However, it's important to choose footwear that still provides suitable support and stability for your activities.

How Is Achilles Bursitis Diagnosed?

If you're experiencing persistent pain or swelling behind your heel, it's worth having the condition properly assessed.

A healthcare professional will generally begin by discussing your symptoms, recent activities and whether particular footwear aggravates the pain. They may examine your heel to identify the location of tenderness, assess your ankle movement and check the Achilles tendon for signs of injury.

In many cases, a clinical examination provides sufficient information to make an initial diagnosis. However, additional investigations may sometimes be recommended.

Ultrasound: An ultrasound can help identify inflammation or excess fluid within the retrocalcaneal bursa and examine the surrounding Achilles tendon.

MRI Scan: An MRI may be recommended when the diagnosis remains uncertain or a more detailed examination of the tendon and surrounding tissues is required.

X-rays: Although X-rays don't directly show inflammation within the bursa, they may help identify a prominent heel bone or other bone-related changes.

Not everyone with suspected Achilles bursitis requires imaging. A clinical examination is generally the starting point. [3]

What Are the Treatment Options for Achilles Bursitis?

If heel pain is beginning to interfere with your everyday activities, your first priority is understandably to find some relief. Treatment generally focuses on reducing irritation around the affected bursa, managing swelling and associated pain, and allowing the surrounding tissues to recover.

1. Rest and Activity Modification

Temporarily reducing activities that aggravate your heel is often a sensible first step. You may need to limit running, longer walks, hill climbing or other activities that consistently increase discomfort.

However, prolonged complete inactivity isn't generally recommended. Gentle movement can often be maintained, provided it doesn't significantly aggravate your symptoms. The aim is to reduce excessive pressure and irritation while avoiding unnecessary stiffness and muscle weakness.

2. Footwear Changes and Heel Support

Because pressure from footwear can contribute to heel bursitis, reviewing the shoes you're wearing is particularly important.

You may benefit from:

• Choosing shoes with a softer, more comfortable heel counter.
• Avoiding footwear that rubs directly against the painful area.
• Using suitable cushioning or padding to reduce friction.
• Considering a temporary heel lift or insole if recommended by a podiatrist or healthcare professional.

A small heel lift may sometimes help reduce pressure around the Achilles tendon attachment and retrocalcaneal bursa. However, heel lifts aren't appropriate for everyone and should be selected according to the underlying condition.

3. Cold and Heat Therapy

When the back of your heel is noticeably swollen or painful following activity, applying a cold pack wrapped in a towel for approximately 10–20 minutes may help reduce discomfort.

For longer-standing stiffness or muscle tension around the calf and ankle, gentle heat may sometimes provide additional comfort. However, avoid applying heat directly over an acutely swollen, unusually hot or red heel.

4. Physiotherapy and Rehabilitation

Physiotherapy can play an important role in managing persistent heel pain, particularly when weakness, limited ankle movement or an associated Achilles tendon problem contributes to symptoms.

During a painful flare-up, strenuous exercises or movements that repeatedly compress the affected bursa may need to be reduced or modified. Gentle, appropriately selected exercises can often be maintained.

As symptoms improve, rehabilitation may focus on:

• Restoring comfortable ankle movement.
• Improving calf muscle strength.
• Addressing muscle weakness or tightness.
• Gradually rebuilding tolerance to walking and other activities.
• Reducing the likelihood of recurring irritation.

One important consideration is that aggressive stretching of the Achilles tendon may aggravate pain near its attachment to the heel, particularly when retrocalcaneal bursitis or insertional Achilles tendinopathy is present. Rehabilitation exercises should therefore be carefully tailored to avoid overstretching or placing unnecessary strain on the affected area.

5. Medication and Medical Treatments

Pain-relieving or anti-inflammatory medication may be recommended to help manage symptoms, although these treatments aren't suitable for everyone.

In some persistent cases, a healthcare professional may consider a corticosteroid injection into the affected bursa. However, injections around the Achilles tendon require particular care because corticosteroids can weaken tendon tissue and increase the risk of tendon injury or rupture.

Surgery is rarely required and is generally reserved for selected cases that haven't responded to appropriate conservative treatment.

6. Drug-Free, Non-Invasive Heel Bursitis Relief with OSMO Patch

If you're looking for a drug-free, non-invasive way to help manage the swelling and associated pain from heel bursitis, OSMO Patch offers a convenient home treatment option designed to work while you sleep.

Simply apply the patch over the affected area before going to bed, following the supplied application instructions. Developed in Australia, OSMO Patch is designed to help reduce swelling and associated discomfort without the use of drugs, steroids or invasive procedures. We recommend using OSMO Patch alongside appropriate rest and footwear changes. 

Discover how OSMO Patch may help you manage heel bursitis swelling and associated pain — so you can get back to enjoying your everyday activities.

→ Learn More About OSMO Patch for Heel Bursitis Relief

(ALWAYS FOLLOW THE DIRECTIONS FOR USE. Not suitable for individuals with seafood or shellfish allergies)

How Long Does Achilles Bursitis Take to Heal?

Recovery times vary depending on the severity of the inflammation, how long symptoms have been present and whether the surrounding Achilles tendon is also affected.

Some uncomplicated cases may improve within several weeks after reducing aggravating activities and making appropriate footwear changes. However, more persistent cases can take longer, particularly when repeated strain, pressure from shoes or an associated tendon problem continues contributing to the discomfort.

Using OSMO Patch alongside adequate rest and avoiding activities that irritate the affected heel may help support the recovery process. By helping to reduce swelling and associated pain, OSMO Patch is designed to provide relief while giving the inflamed bursa an opportunity to settle.

It's worth remembering that feeling less pain doesn't necessarily mean the affected tissues have fully recovered. Returning too quickly to strenuous activities may aggravate the area and prolong recovery. If you wish to continue exercising, activities should be tailored to avoid unnecessary stress or pressure on the affected heel.

 

Frequently Asked Questions About Achilles Bursitis

Why Does the Back of My Heel Hurt When I Put My Shoes On?

Pain when wearing enclosed shoes may occur because the back of the shoe presses against an inflamed bursa or other sensitive tissues around the heel. This is particularly common when the heel counter is firm or tight.

Changing to more comfortable footwear may help, but persistent heel pain should be properly assessed to identify the underlying cause.

Is Achilles Bursitis the Same as Achilles Tendonitis?

No. Achilles bursitis affects a fluid-filled cushioning sac around the heel, while Achilles tendonitis or tendinopathy affects the tendon itself.

Both conditions can cause pain at the back of the heel and may occur together. A healthcare professional can help determine which structures are contributing to your symptoms.

Can I Keep Walking if I Have Achilles Bursitis?

Gentle walking may be possible if it doesn't significantly aggravate your symptoms. However, longer distances, hills and repeated stair climbing can increase pressure around the Achilles tendon and heel.

Temporarily reducing your walking distance and avoiding activities that consistently worsen the pain may help.

Why Have I Developed a Lump at the Back of My Heel?

A lump at the back of your heel may be associated with swelling of a superficial bursa, a prominent heel bone, tendon thickening or another condition.

For example, Haglund's deformity involves a bony prominence at the upper back of the heel that can sometimes contribute to irritation. Not every lump is caused by bursitis, so a new or persistent swelling should be examined by a healthcare professional.

Should I Use Ice or Heat for Achilles Bursitis?

Cold therapy may help manage discomfort when the heel is recently irritated or noticeably swollen. Gentle warmth may be more suitable for ongoing calf muscle stiffness or tightness.

However, avoid applying heat to a heel that is unusually hot, red or significantly swollen, and seek medical advice if infection is suspected.

Can Achilles Bursitis Heal Without Surgery?

Yes. Many cases improve with conservative treatment, including activity modification, appropriate footwear, pain management and rehabilitation.

Surgery is rarely required for uncomplicated heel bursitis. However, persistent symptoms may require further investigation, particularly if an underlying Achilles tendon problem is contributing to the pain.

 

When Should You Seek Medical Attention?

If pain or swelling at the back of your heel persists, worsens or begins interfering significantly with walking or everyday activities, consult a qualified healthcare professional.

Seek urgent medical attention if you experience sudden severe pain following an injury, hear or feel a pop near your Achilles tendon, or suddenly find it difficult to push off your foot. These symptoms may indicate an Achilles tendon rupture.

Increasing redness, warmth, swelling or pain accompanied by fever also requires prompt medical assessment.

Medical References

[1] MedlinePlus – U.S. National Library of Medicine: Bursitis of the Heel. Read the medical reference

[2] van Dijk CN, et al: Terminology for Achilles Tendon Related Disorders. Knee Surgery, Sports Traumatology, Arthroscopy. Read the published medical research

[3] NHS – Bexley Musculoskeletal Service: Retro-calcaneal Bursitis. Read the NHS medical guidance

[4] Hospital for Special Surgery: Retrocalcaneal Bursitis. Read the medical resource