Heel Bursitis: Understanding Causes, Symptoms, and Recovery

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 15, 2026

Quick Answer

Heel bursitis is a condition in which the small, slippery sacs called bursae in the heel become irritated and inflamed [1], causing localized pain and swelling. Common causes include repetitive activities like running, sudden increases in workout intensity and tight shoes [1]. Treatment focuses on reducing inflammation with rest, icing and stretching [1], and prevention centers on supportive footwear.

What the research says

• Most heel bursitis responds to non-surgical care. A review in the Journal of the American Academy of Orthopaedic Surgeons found that most patients with bursitis respond to ice, activity modification, and anti-inflammatory medicines, and it cautioned that steroid injection into the retrocalcaneal bursa may adversely affect the biomechanical properties of the Achilles tendon (Aaron et al., J Am Acad Orthop Surg, 2011) [2].

• Shoe changes can control the pain. A narrative review of rearfoot disorders reported that retrocalcaneal bursitis pain can be controlled by lifting the heel and loosening the shoe counter, though the authors note more clinical studies are needed (Choo et al., Ann Palliat Med, 2020) [3].

• Surgery works when conservative care fails. A systematic review of 20 studies on surgery for Haglund's deformity, a common driver of retrocalcaneal bursitis, found both open and endoscopic surgery significantly improved functional (AOFAS) scores and patient satisfaction, with endoscopic surgery showing shorter operative times and fewer complications (Yuen et al., Cureus, 2022) [4].

Overview of Heel Bursitis

Heel bursitis is a common inflammatory condition that affects the cushioning sacs surrounding the heel bone. These sacs, known as bursae, serve as vital lubricants that prevent bones from rubbing against muscles, tendons, or skin during movement. When these sacs become irritated, they swell with fluid, causing significant discomfort that can hinder mobility and daily activities [1].

Key Takeaways: Heel Bursitis Facts

Types of Heel Bursitis

There are two primary forms of this condition, distinguished by the specific bursa that becomes inflamed. Understanding which type is present is essential for selecting the most effective management strategy.

• Retrocalcaneal Bursitis: This is the most prevalent form, also known as Achilles tendon bursitis. It occurs when the bursa situated between the heel bone (calcaneus) and the Achilles tendon becomes inflamed [1].

• Subcutaneous Calcaneal Bursitis: This type involves the bursa located between the skin and the back of the Achilles tendon [1], often aggravated by external pressure from footwear.

Symptoms and Clinical Presentation

The symptoms of heel bursitis typically develop gradually and are most noticeable during or after physical activity. The localized nature of the pain helps distinguish it from other foot conditions like plantar fasciitis.

Commonly reported symptoms include:

• Localized Pain: Persistent aching or sharp pain specifically in or behind the heel area [1].

• Swelling and Tenderness: Visible puffiness and sensitivity to touch around the back of the foot.

• Functional Pain: Increased discomfort when standing on tip-toes [1] or flexing the foot upward.

• Inflammatory Signs: Noticeable warmth and skin color changes (redness or darkening) in the affected region [1].

Causes and Risk Factors

Heel bursitis is primarily an overuse injury, but several biological and environmental factors can contribute to its development. Repetitive mechanical stress is the most frequent trigger.

Common Causes

The condition often stems from activities that place repeated strain on the ankle and heel. These include:

• High-Impact Activities: Frequent running, jumping, or long-distance walking [1].

• Sudden Intensity Shifts: Quickly increasing the duration or difficulty of a workout routine without proper conditioning [1].

• Improper Preparation: Failing to stretch the calf muscles and Achilles tendon before exercise [1].

• Footwear Issues: Wearing shoes that are excessively tight or have a rigid heel counter that rubs against the back of the foot [1].

• Infection: In rare instances, a bacterial infection can cause septic bursitis, requiring immediate medical attention [1].

Associated Medical Conditions

Certain underlying health issues can increase an individual's susceptibility to developing heel bursitis. These inflammatory and structural conditions include:

• Haglund’s deformity (a bony enlargement on the back of the heel).

• Rheumatoid arthritis and psoriatic arthritis.

• Gout and pseudogout.

• Ankylosing spondylitis [1].

Diagnosis and Professional Evaluation

A healthcare provider typically diagnoses heel bursitis through a combination of medical history review and a physical examination. They will assess the foot's range of motion and look for specific signs of inflammation.

Diagnostic Procedures

• Physical Examination: Testing for tenderness, swelling, and the ability to perform functional movements like standing on toes [1].

• Imaging Tests: X-rays are used to rule out bone abnormalities, while MRI or ultrasound can provide detailed views of the soft tissues and bursae to confirm inflammation [1].

• Fluid Analysis: If an infection is suspected, a provider may perform bursal aspiration to test the fluid for bacteria [1].

Management and Treatment Strategies

The majority of heel bursitis cases respond well to conservative, non-surgical treatments [2]. The goal is to reduce inflammation and remove the source of irritation.

Self-Care and Home Remedies

• Activity Modification: Resting the foot and avoiding activities that exacerbate the pain is the first step in recovery [1].

• Cryotherapy: Applying ice packs for 20 minutes several times a day [1] helps manage swelling and pain.

• Footwear Adjustments: Switching to shoes with U-shaped or V-shaped heel collars can reduce pressure on the Achilles tendon [1].

• Medication: Over-the-counter anti-inflammatory drugs (NSAIDs) like ibuprofen can provide temporary relief [1].

Professional Interventions

• Orthotics: Using heel wedges or custom inserts can improve foot alignment and reduce bursa irritation [1].

• Physical Therapy: Targeted calf stretches and strengthening exercises [1] are highly effective for long-term relief.

• Advanced Options: In rare or chronic cases, a provider may recommend steroid injections or a surgical bursectomy to remove the damaged sac [1].

Prevention and Long-Term Health

Preventing heel bursitis involves maintaining flexibility and choosing appropriate equipment for physical activities.

• Consistent Stretching: Incorporate regular calf and heel stretches into daily routines [1].

• Gradual Progression: Increase exercise intensity slowly [1] to allow the body to adapt to new stresses.

• Quality Footwear: Replace worn-out shoes and ensure all footwear provides adequate support and cushioning [1].

• Surface Awareness: When possible, choose softer running or walking surfaces to minimize impact [1].

Conclusion

Heel bursitis is a manageable condition that serves as a signal that the foot is under excessive stress. By prioritizing rest, proper stretching, and supportive footwear, most individuals can achieve a full recovery and return to their active lifestyles. If pain persists despite home care, consulting a healthcare professional is essential for a tailored treatment plan.

Frequently Asked Questions

What exactly is a bursa?

A bursa is a small, fluid-filled sac that acts as a cushion between bones and soft tissues like tendons and muscles.

Is heel bursitis the same as plantar fasciitis?

No. Heel bursitis affects the bursae behind or under the heel, while plantar fasciitis involves the thick band of tissue along the bottom of the foot.

Can I walk with heel bursitis?

Walking is possible, but you should limit it if it causes pain, as continued irritation can worsen the inflammation.

Why does my heel hurt more in the morning?

Inflammation can settle overnight, making the area stiff and painful when you first start moving in the morning.

How long does it take for heel bursitis to go away?

Most people see significant improvement within 2 to 3 weeks of consistent home treatment.

Can tight shoes cause this condition?

Yes, shoes that rub against the back of the heel are a leading cause of subcutaneous calcaneal bursitis.

What is retrocalcaneal bursitis?

It is the inflammation of the bursa located between the heel bone and the Achilles tendon.

Are there exercises I should avoid?

Avoid high-impact jumping, sprinting, or uphill running until the inflammation has subsided.

Should I see a doctor for heel pain?

Yes, if the pain is severe, accompanied by a fever, or does not improve after two weeks of rest.

What are heel wedges?

Heel wedges are orthotic inserts that slightly lift the heel to reduce tension on the Achilles tendon and the bursa.

Can gout cause heel bursitis?

Yes, gout can lead to inflammatory changes in the bursae throughout the body, including the heel.

Is icing better than heat for bursitis?

Icing is generally preferred for bursitis as it directly reduces the swelling and inflammation.

What does “septic bursitis” mean?

It means the bursa has become infected with bacteria, which is a medical emergency requiring antibiotics.

Can children get heel bursitis?

Yes, active children, especially those in sports, can develop bursitis due to overuse or growth spurts.

What is a bursectomy?

A bursectomy is a surgical procedure to remove an inflamed or damaged bursa.

Does stretching help?

Yes, stretching the calf muscles helps reduce the mechanical pull on the Achilles tendon and the underlying bursa.

Can I use ibuprofen for the pain?

Yes, NSAIDs like ibuprofen are commonly used to manage the pain and inflammation associated with bursitis.

What is Haglund's deformity?

It is a bony bump on the back of the heel that can rub against shoes and irritate the bursa.

How do I know if I have an infection?

Signs of infection include intense warmth, redness, fever, chills, and severe pain.

Can I still exercise with bursitis?

You should switch to low-impact activities like swimming or cycling that don't place stress on the heel.

What is the Achilles tendon?

It is the large tendon that connects your calf muscles to your heel bone.

Does bursitis cause permanent damage?

Usually no, provided it is treated correctly and not allowed to become a chronic, untreated issue.

Can obesity contribute to heel bursitis?

Yes, extra weight places more pressure on the structures of the foot, including the bursae.

What is an MRI used for in diagnosis?

An MRI helps providers see soft tissue details and rule out other issues like tendon tears.

Are custom orthotics necessary?

Not always, but they can be very helpful for people with structural foot issues that cause recurring bursitis.

What is the difference between bursitis and tendinitis?

Bursitis is inflammation of the cushioning sac, while tendinitis is inflammation of the tendon itself.

Can I use a compression sleeve?

A light compression sleeve may help manage swelling, but ensure it doesn't rub the back of the heel.

Why is rest so important?

Rest allows the body's natural inflammatory response to subside without constant re-injury.

Can flat feet cause heel bursitis?

Yes, flat feet can alter how you walk, placing unusual stress on the heel bursae.

What is the best type of shoe for this?

Look for shoes with good arch support and a soft or open back to avoid pressure on the heel.

Can I use a foam roller?

Foam rolling the calves can help loosen the muscles that pull on the heel, providing indirect relief.

Is bursitis common in runners?

Yes, it is one of the most frequent overuse injuries seen in the running community.

What is “subcutaneous” bursitis?

It refers to inflammation in a bursa located just beneath the skin.

Can I go barefoot?

Going barefoot may increase the strain on your heel; supportive indoor footwear is usually better.

Does aging affect bursitis risk?

Yes, bursae can become less efficient and more prone to irritation as we age.

What is bursal aspiration?

It is the process of using a needle to drain excess fluid from an inflamed bursa.

Can stress cause bursitis?

Not directly, but stress can lead to muscle tension that increases the risk of overuse injuries.

Is physical therapy painful?

It should involve gentle stretching; if an exercise causes sharp pain, it should be adjusted.

Can I take a warm bath?

A warm bath can relax muscles, but avoid applying direct heat to a very swollen heel.

How often should I ice my heel?

Icing 3 to 4 times a day for about 20 minutes is a standard recommendation.

What is the calcaneus?

It is the anatomical name for the heel bone.

Can antibiotics treat all bursitis?

No, antibiotics only work if the bursitis is caused by a bacterial infection.

Is surgery the only way to fix Haglund's deformity?

Surgery is usually a last resort; most cases are managed by changing footwear.

Can I use a heel lift?

Yes, a heel lift is similar to a wedge and can help reduce strain on the back of the foot.

Does diet affect bursitis?

An anti-inflammatory diet may help, especially if the bursitis is related to conditions like gout.

What is the “U-shaped” shoe collar?

It is a design where the back of the shoe is cut lower to avoid pressing on the Achilles tendon.

Can I use kinesiology tape?

Some people find relief with taping, but it should be applied by a professional for the best results.

Is heel bursitis a chronic condition?

It can become chronic if the underlying cause (like poor shoes or form) is not addressed.

What is a podiatrist?

A podiatrist is a medical doctor who specializes in the treatment of foot and ankle disorders.

Can I prevent this entirely?

While not guaranteed, proper conditioning and footwear significantly reduce your risk.

Further Reading

• Merck Manual Consumer Version. Achilles Tendon Bursitis. Last updated October 2025.

• American Family Physician. Bursitis of the Elbow, Knee, and Heel. Information from Your Family Doctor; Feb 15, 2017.

Sources

1. Cleveland Clinic. Heel Bursitis. Cleveland Clinic. Last updated March 5, 2025. https://my.clevelandclinic.org/health/diseases/21706-heel-bursitis

2. Aaron DL, Patel A, Kayiaros S, et al. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011;19(6):359-367. PMID 21628647. https://doi.org/10.5435/00124635-201106000-00006

3. Choo YJ, Park CH, Chang MC. Rearfoot disorders and conservative treatment: a narrative review. Ann Palliat Med. 2020;9(5):3546-3552. PMID 32787369. https://doi.org/10.21037/apm-20-446

4. Yuen WLP, Tan PT, Kon KKC. Surgical Treatment of Haglund's Deformity: A Systematic Review and Meta-Analysis. Cureus. 2022;14(7):e27500. PMID 36060327. https://doi.org/10.7759/cureus.27500

Disclaimer

The information provided in this article is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of any health condition.