Heel bursitis: causes, symptoms, and treatment tips

Key takeaways:

1. Heel bursitis is caused by irritation or inflammation of the fluid-filled bursa at the back of the heel.

2. Even if heel pain makes movement uncomfortable, staying active with gentle modifications and regular activity helps support healing and keeps your feet healthy.

3. Stretching and strengthening exercises for your calves, Achilles tendon, and feet can relieve and prevent discomfort from heel bursitis (see videos below).

Hinge Health offers virtual physical therapy and more to help you manage foot or ankle pain. Learn more.

Your heel is one of those body parts that you probably don’t think about often. But when it’s in pain, it’s hard to ignore how central it is to pretty much all of your daily activities, like the simple act of walking, reaching for something on a high shelf, or pushing off when you get out of a chair. Given how integral your heels are, it’s not surprising that heel pain is pretty common — and heel bursitis, which strikes at the back of the heel, is a common cause.

If you’ve heard of bursitis before, it may be because there are many forms of it. There are hundreds of bursae (little fluid-filled sacs) all over the body, including around your knees, hips, shoulders, and elbows. They act as a gliding surface to cushion an area where bones would otherwise rub on muscles, tendons, or skin, to prevent friction and inflammation during movement. Anywhere there’s bursae, there’s always the potential for bursitis. 

Heel bursitis is caused when the bursa at the back of the heel bone becomes inflamed. It can affect your ability to move your foot or ankle, which can disrupt your daily life. When you have heel pain from bursitis, it can be challenging to walk. Your heel might feel tender to the touch. Wearing shoes might be uncomfortable.

The good news: Heel bursitis can usually be managed at home with proper treatment, which includes exercise therapy for your feet and ankles, says Lori Walter, PT, DPT, a physical therapist at Hinge Health. Though your instinct may be to rest and avoid movement, “continuing to move can help you heal and recover,” says Dr. Walter. 

Read on to learn more about what causes heel bursitis, common symptoms, and how to prevent and treat it, especially with exercises from our Hinge Health physical therapists.

What is heel bursitis?

Heel bursitis is specific to the bursa in your heel, which is known as the retrocalcaneal bursa. It’s located in the back of your ankle, in the space between your heel bone (calcaneus) and your Achilles tendon, the thick cord at the back of your foot that connects the calf muscles to the heel bone. 

The location of the pain is a clue to the possible cause. “Heel bursitis occurs right at the junction where the Achilles tendon comes into the heel bone — it can be slightly lower than that junction but not underneath it,” says Dr. Walter. “If the pain feels like it is more underneath the heel, that’s more likely to be plantar fasciitis. If it's a little higher, it could be tendinitis of the Achilles.” 

Symptoms of heel bursitis

The main symptom of heel bursitis is pain at the back of the ankle and heel. As the bursa becomes irritated, more fluid than usual collects inside it, causing it to swell. This swelling creates pressure and can make certain everyday movements — walking, jumping, and going up and down stairs — more difficult. Sometimes even just standing can be painful when you have heel bursitis. Standing on your toes, which pulls on the Achilles tendon and creates compression across the bursa, can be especially uncomfortable. 

You may also experience tenderness, redness, and warmth in your heel. “The more irritated the bursa is, the more you’re going to see swelling and redness,” says Dr. Walter.

Causes of heel bursitis

“Usually, with heel bursitis, there’s a change that triggers it, such as a change in footwear or a change in activity,” says Dr. Walter. Here are some common reasons you may experience heel bursitis:

• Repeated use of the ankle, such as from standing, walking, running, or jumping more than usual. Running or walking uphill, which causes the foot to flex more than it is used to, can be irritating to the retrocalcaneal bursa until your body adjusts to these activities. 

• Not stretching as much as your body needs. Skipping stretching or not warming up before exercise increases the risk of developing heel bursitis. This is especially true if you're starting a new exercise program or ramping up your regular workouts. Without stretching and proper muscle conditioning, you can strain the calf muscles and the Achilles tendon, which, in turn, can put stress on the bursa. 

• Poorly fitting shoes. Too tight or inflexible shoes can put pressure on the bursa and cause it to become irritated and inflamed.

• Inflammatory joint diseases. Certain types of inflammatory arthritis like gout and rheumatoid arthritis can be associated with heel bursitis, mainly because they affect your gait and mobility, explains Dr. Walter. “Arthritis in your foot can affect how you move your ankle, which can cause irritation in the bursa.”

Even though certain types of movements may contribute to heel bursitis, that doesn’t mean you should stop moving. Instead, continue being active while adding leg, ankle, and foot stretches and strengthening moves to your routine. This combination will help train your heels and pain system to adapt and handle these activities with less pain.

Treatment options for heel bursitis

Heel bursitis usually improves after a few weeks of home treatment and some activity modifications. Here are some simple strategies to help:

• Add gentle leg and heel exercises to your routine. At-home exercises that add strength and flexibility in your legs and heels help keep your heels healthy and relieve pressure on the bursa. See some examples below.

• Try physical therapy. This will focus on stretching your Achilles tendon and strengthening the surrounding area to take pressure off your heel bursa. Not only will it help heal your heel, it can also play a role in preventing the bursitis from coming back. You can see a physical therapist in person or use a program like Hinge Health to access a PT via a telehealth or video visit. 

• Employ ice and elevation. Putting your feet up and cooling your heels (literally!) can help ease pain and inflammation. Dr. Walter recommends elevating your heel a few times a day after you’ve been on it for an extended period and rubbing the back of your sore heel with an ice cup several times a day at five-minute intervals.  

• Make some adjustments to irritating activities. Dr. Walter recommends changing intensity: “If running and jumping hurt, then decrease those aggravating activities, but continue to move,” she says. For instance, you could walk instead of run, or cut back on the time or distance you run and gradually increase it as you feel better. Other little tweaks can help you continue to be active. For instance, using a heel wedge (more on that below) to reduce irritation in your heel can allow you to continue to walk with greater ease. 

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for heel bursitis pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Use shoe inserts. Orthotics can encourage proper walking form and reduce irritation in your heel. A heel wedge lifts the heel slightly to put a bit of slack in the Achilles tendon and take pressure off the bursa. Both can be bought in a store or custom-made by a healthcare provider. 

Heel bursitis prevention tips

If you’re prone to heel bursitis there are many things you can do to manage and prevent it, such as:

• Wear comfortable, supportive footwear. There's no such thing as the “perfect” shoe that works for everyone. But, in general, people with heel bursitis may do well by avoiding shoes that are too tight or have a stiff heel. Choose athletic shoes with enough arch support and an “Achilles notch,” a groove in the back collar of the shoe to support your Achilles tendon. Most shoes have them, but check to be sure. When appropriate, consider open-backed shoes, which can avoid placing pressure on the heel. 

• Strengthen above and below the ankle. “When you have good strength on the underside of the foot, from doing exercises like arch raises, it can help control the movement of walking and running. Strengthening the hip, like with standing side leg lifts, can also help reduce strain down to the foot,” says Dr. Walter. 

• Maintain a healthy weight for you. Losing a few pounds if that’s healthy for you can help affect how your muscles function around the bursa. 

These exercises can relieve heel bursitis and may help prevent future flare-ups. Don’t be surprised that they all target your calf muscles and Achilles tendon. When these areas are strong, flexible, and healthy, your heels and bursa are more protected from irritation. Aim to do the exercises at least once a day to get blood flowing, promote healing, and improve mobility. They’re great movement snacks to break up long periods of sitting. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

When to see a doctor

If your heel bursitis pain isn’t improving after a few weeks of ice, gentle movement, and other at-home measures, it may be time to see a doctor to rule out more serious issues. See a doctor if:

• You have a fever. In rare cases, a bacterial infection can cause heel bursitis. If the bursa becomes infected, you may also experience a fever. This requires immediate medical attention.

• The pain and swelling gets worse, to the point where it’s so severe you can’t put weight on the affected foot.

• The pain affects more than just your heel, which could signal another root cause beyond bursitis.

PT tip: Try the alphabet game

Easing into movement when your heel hurts is a good way to help your body be more resilient. “Drawing the alphabet or doing little ankle circles with your foot decreases pain through a process called graded exercise,” says Dr. Walter. “When you start with a small, non-painful motion and incrementally increase the size of the letters or circles, the nervous system adapts to the movement.” With more mobility and less pain, your muscles start to relax and your nervous system calms, which allows you to regain confidence that you can tolerate more movement.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Bursitis of the heel. (2022, September 20). Icahn School of Medicine at Mount Sinai. https://www.mountsinai.org/health-library/diseases-conditions/bursitis-of-the-heel

2. Heel Bursitis. (2021, August 17). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21706-heel-bursitis

3. Whitten, C. (2021, December 2). What to Know about Heel Bursitis. WebMD. https://www.webmd.com/pain-management/what-to-know-about-heel-bursitis

4. Masci, L. (2021, May 16). Heel Bursitis: What Does It Mean and What Should You Do? Sport Doctor London. https://sportdoctorlondon.com/heel-bursitis/

5. Burks, J. (2021, March 25). Heel (Retrocalcaneal and Calcaneal) Bursitis. Arthritis-health. https://www.arthritis-health.com/types/bursitis/heel-retrocalcaneal-and-calcaneal-bursitis