A 28 year old presented with complaints of pain around the back of the left Achilles. The pain was worse when walking long distances and when moving from a seated position to standing. They had previously had cortisone injection into the Achilles which had provided minimal benefit.
There was reduced ankle joint dorsiflexion and there are prominent haglunds deformities present.
Performing an ultrasound of the foot indicted a large Retrocalcaneal bursa (Retrocalcaneal bursitis) and Achilles Tendinopathy (click for more information)
Bursa’s are normally present to provide a cushion for tendons to move over bones. When the tendon rubs excessively or there is a bony prominence this can irritate the bursa causing it to swell.
Both of these problems are made worse with high activity and with the presence of a haglunds deformity.
To treat the retrocalcaneal bursitis and the Achilles tendinopathy the treatment options include:
- Aspiration of the bursa
- Alfredson eccentric exercises
- Shockwave therapy for the Achilles tendon
- Massage
- Acupuncture
- Heel inserts
- More supportive shoes
- Night splints (Strassburg sock)
The bursa was aspirated with an 18 gauge needle and shockwave therapy was provided for the Achilles tendon. They were told to perform the Alfredson Eccentric Exercises . Below is the fluid that was aspirated from the bursa and the images taken of the Achilles after the bursa was aspirated. The Achilles is still disorganised but there is a reduction in the black area in the Achilles
