Achilles Bursitis

Injuries > Achilles & Heel > Achilles Bursitis

What is Achilles bursitis?

A bursa is a very thin fluid filled sac found in various places throughout the body. Bursae are filled with lubricating fluid and are designed to reduce friction between layers of tissue. They are located in regions of the body where tissue layers may rub against each other or against bony prominences (figure 1).

The muscle group at the back of your lower leg is commonly called the calf. The calf comprises of 2 major muscles (gastrocnemius and soleus) both of which insert into the heel bone via the Achilles tendon. Between the Achilles tendon and skin lies a bursa known as the Achilles bursa (figure 1).

During contraction of the calf, tension is placed through the Achilles tendon and this rubs against the Achilles bursa. Rubbing of objects against the heel such as excessively tight shoes can also increase friction on the Achilles bursa. When this friction is excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. This condition is called Achilles bursitis.

(N.B. Achilles bursitis is not to be confused with the more commonly seen Retrocalcaneal Bursitis which also presents in a similar region of the Achilles).

Signs and symptoms of Achilles bursitis

Patients with Achilles bursitis typically experience pain during activities requiring strong or repetitive calf contractions such as walking (especially uphill), going up and down stairs, running, jumping or hopping. Often pain may be worse with rest after these activities (especially that night or the following morning). Pain may also increase when wearing either loose or excessively tight shoes that rub against the Achilles bursa. Other symptoms may include swelling in the local area and tenderness on firmly touching the Achilles bursa.

Causes of Achilles bursitis

Achilles bursitis is often caused by excessive friction on the skin overlying the Achilles tendon, such as from wearing poorly fitted shoes. Overuse activities involving repetitive calf contractions, such as walking or running excessively, can also contribute to the development of the condition. Occasionally the condition may develop following trauma such as a direct impact to the Achilles Bursa.

Diagnosis of Achilles bursitis

A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose Achilles bursitis. Diagnosis may be confirmed, most commonly with an ultrasound investigation, or sometimes with a MRI or CT scan.

Treatment for Achilles bursitis

Most patients with Achilles bursitis heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities that cause a delayed increase in pain (especially the following morning) should also be avoided. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.

Ignoring symptoms or adopting a 'no pain no gain' attitude is likely to lead to the condition becoming chronic. Once chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence. Immediate appropriate treatment in all patients with Achilles bursitis is vital to ensure an optimal outcome. 

Because poorly fitted or inappropriate footwear is often the cause of Achilles bursitis, biomechanical correction and footwear advice is essential for effective treatment of this condition.

Regular icing and anti-inflammatory medication may help to significantly reduce inflammation in the initial phase of this condition. A graduated flexibility, strength and return to activity program under direction from the treating physiotherapist is vital to ensure an optimal outcome.

Contributing factors to the development of Achilles bursitis

There are several factors which can predispose patients to developing Achilles bursitis. These need to be assessed and corrected with direction from a physiotherapist and may include:

• inappropriate or poor footwear
• abnormal foot biomechanics
• poor flexibility (particularly of the calf muscles)
• inappropriate or excessive training
• muscle weakness
• joint stiffness

Physiotherapy for Achilles bursitis

Physiotherapy treatment is vital in all patients with Achilles bursitis to hasten the healing process, ensure an optimal outcome and prevent recurrence. Treatment may comprise:

• footwear advice
• soft tissue massage
• electrotherapy (e.g. ultrasound)
• anti-inflammatory advice
• stretches
• joint mobilization
• ice or heat treatment
• exercises to improve strength, flexibility and balance
• the use of heel wedges
• education
• activity modification advice
• biomechanical correction
• a graduated return to activity program

Other intervention for Achilles bursitis

Despite appropriate physiotherapy management, some patients with Achilles bursitis do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may include corticosteroid injection into the Achilles bursa, further investigations such as an ultrasound, MRI or CT scan, or review by a specialist or podiatrist who can advise on any treatment that may be appropriate to improve the condition. The podiatrist may sometimes recommend an orthotic or shoe insert to modify the biomechanics of the foot or shoe.

Exercises for Achilles bursitis

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms.

Lunge Stretch

Begin this exercise with your hands against the wall. Place the leg to be stretched in front of you as demonstrated. Keep your heel down. Gently move your knee forward over your toes until you feel a stretch in the back of your calf or Achilles tendon (figure 2). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.

Figure 2 – Lunge Stretch (right leg)

Calf Stretch

Begin this exercise with your hands against the wall. Place the leg to be stretched behind you as demonstrated. Keep your heel down, knee straight and feet pointing forwards. Gently lunge forwards until you feel a stretch in the back of your calf, knee or Achilles tendon (figure 3). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.

Figure 3 – Calf Stretch (left leg)

Find a Physio for Achilles bursitis

Find a physiotherapist in your local area who can treat this condition.

More Information

• View more Calf Flexibility Exercises.
• View Calf Strengthening Exercises.
• View Balance Exercises.
• View the Diagnosis Guide for Achilles & Heel Pain.

Physiotherapy products for Achilles bursitis

Some of the most commonly recommended products by physiotherapists for patients with this condition include:

1. Ice Packs or Heat Packs
2. Heel Wedges
3. Wobbleboards or Duradiscs
4. Foam Rollers

To purchase physiotherapy products for Achilles bursitis click on one of the above links or visit the PhysioAdvisor Shop.

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