Retrocalcaneal Bursitis

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Retrocalcaneal Bursitis

Authors, Editors, Case Information Author: Gerald Megna, MD Affiliation: Self Regional Healthcare Sports Medicine Co Author(s): Dr. Jacob Ringenberg Senior Editor: William Berrigan, MD Clinical Vignette: A 21-year-old female presented with non-traumatic right heel pain for approximately 3 months. Exam was notable for tenderness on calcaneal squeeze and tenderness to palpation deep to the achilles tendon. Pain was worse with passive and active dorsiflexion of the ankle. Type of Probe Used: 15-4 linear Unlabeled Long Axis View of the Achilles Tendon Insertion Unlabeled Long Axis View of the Achilles Tendon Insertion Unlabeled Long Axis View of the Achilles Tendon Insertion with Color Doppler Unlabeled Long Axis View of the Achilles Tendon Insertion with color doppler showing increased vascularity around the retrocalcaneal bursa. Labeled Long Axis View of the Achilles Tendon Insertion Labeled Long Axis View of the Achilles Tendon Insertion retrocalcaneal bursa. A moderate amount of fluid is seen expanding the retrocalcaneal bursa. The achilles tendon appears normal, with no thickening or tearing. Unlabeled Short Axis View of the Distal Achilles Tendon Unlabeled Short Axis View of the Distal Achilles Tendon Unlabeled Short Axis View of the Distal Achilles Tendon with Color Doppler Unlabeled Short Axis View of the Distal Achilles Tendon with Color Doppler showing increased vascularity surrounding the retrocalcaneal bursa. Labeled Short Axis View of the Distal Achilles Tendon Labeled Short Axis View of the Distal Achilles Tendon and retrocalcaneal bursa. A moderate amount of fluid is seen expanding the retrocalcaneal bursa. Interpretation Image Interpretation: There is a moderate amount of fluid in the retrocalcaneal bursa. The bursal tissue is hypertrophic with hyperemia noted on color doppler. The achilles tendon is intact with normal echotexture. Teaching Pearl: When evaluating the retrocalcaneal region, use generous gel and light transducer pressure, especially in long axis, to avoid compressing the bursa and losing image quality. A neutral or slightly dorsiflexed ankle can help maintain transducer contact. Ultrasound can identify retrocalcaneal bursal fluid, synovial hypertrophy, Doppler hyperemia, and associated Achilles insertional pathology. It's important to localize posterior heel pain precisely because retrocalcaneal bursitis, superficial bursitis, insertional Achilles tendinopathy, and calcaneal stress injury can overlap clinically. References: 1. Page P, Manske RC, Voight M, Wolfe C. Diagnostic musculoskeletal ultrasound of the Achilles tendon. Int J Sports Phys Ther. 2025;20(2). doi:10.26603/001c.129050 2. Pass B, Robinson P, Ha A, Levine B, Yablon CM, Rowbotham E. The Achilles tendon: imaging diagnoses and image-guided interventions. AJR Am J Roentgenol. 2022;219(3):355-368. doi:10.2214/AJR.22.27632 3. Zellers JA, Bley BC, Pohlig RT, Alghamdi NH, Silbernagel KG. Frequency of pathology on diagnostic ultrasound and relationship to patient demographics in individuals with insertional Achilles tendinopathy. Int J Sports Phys Ther. 2019;14(5):761-769. doi:10.26603/ijspt20190761
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Achilles Tendon Insertion

Unlabeled Long Axis View of the Achilles Tendon Insertion with Color Doppler

Labeled Long Axis View of the Achilles Tendon Insertion

Unlabeled Short Axis View of the Distal Achilles Tendon

Unlabeled Short Axis View of the Distal Achilles Tendon with Color Doppler

Labeled Short Axis View of the Distal Achilles Tendon

Interpretation

UPCOMING EVENTS

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