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Posterior
Achilles tendon bursitis is inflammation of a bursa that forms in
response to shoe pressure and is located at the top edge of the posterior
shoe counter between the skin and Achilles tendon.
This disorder occurs mainly in young women. Use of high-heeled shoes is a risk factor. Many patients have a bony prominence (Haglund's deformity) on the calcaneus.
Symptoms and Signs
Symptoms and signs develop at the top edge of the posterior shoe counter. Early symptoms may be limited to redness, pain, and warmth. Later, superficial skin erosion may occur. After months or longer, a fluctuant, tender, cystic nodule 1- to 3-cm in diameter develops. It is red or flesh-colored. In chronic cases, the bursa becomes fibrotic.
Diagnosis
The presence of the small, tender, flesh-colored or red nodule in a patient with compatible symptoms is diagnostic. Rarely, Achilles tendon xanthoma develops at the top edge of the posterior shoe counter but tends to be pink and asymptomatic. Achilles tendon enthesopathy causes pain mainly at the tendon's insertion but may also cause pain at the top edge of the posterior shoe counter. Enthesopathy is differentiated by the absence of a soft-tissue lesion.
Treatment
Properly fitting shoes with low heels are essential. A foam rubber or felt heel pad may be needed to lift the heel high enough so that the bursa does not hit the shoe counter. Padding around the bursa or the wearing of a backless shoe until inflammation subsides is indicated. Foot orthotics may enhance rear foot stability and help reduce irritating motion on the posterior calcaneus while walking. Warm or cool compresses, NSAIDs, and intrabursal injection of a local anesthetic/corticosteroid offer temporary relief; the Achilles tendon itself must not be injected. Surgical removal of a portion of the underlying bone may rarely be necessary to reduce soft-tissue impingement.
Last full review/revision March 2008 by Kendrick Alan Whitney, DPM
Content last modified March 2008
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