- Heel bursitis is inflammation of the bursa — a fluid-filled cushioning sac — at the back of the heel, between the Achilles tendon and the heel bone.
- It causes pain at the back of the heel that's worse with activity, sometimes with visible swelling or warmth.
- It's commonly confused with Achilles tendonitis, plantar fasciitis, Haglund's deformity, and heel-pad atrophy — proper diagnosis matters because the treatments differ.
- Most cases resolve with relative rest, footwear changes, ice, orthotics, and PT.
- Stubborn cases respond well to corticosteroid injection or aspiration; surgery is rarely needed.
What is heel bursitis?
A bursa is a small fluid-filled sac that sits between two structures to reduce friction — like a cushion. Around the heel, there are two important bursae: the retrocalcaneal bursa, which sits between the Achilles tendon and the heel bone, and the subcutaneous calcaneal bursa, which sits between the Achilles and the skin. When either becomes inflamed, the result is heel bursitis.
Heel bursitis is usually triggered by overuse — a new running program, increased mileage, or a sudden ramp-up in standing time at work — combined with footwear that rubs or compresses the back of the heel. People with arthritis or a prominent heel bone (Haglund's deformity) are at higher risk. Patients describe a deep, achy pain at the back of the heel that worsens with activity and may produce visible swelling.
At Northwest Extremity Specialists, the first job is to make sure it's actually bursitis and not Achilles tendonitis, insertional Achilles tendinopathy, plantar fasciitis, or a bony deformity — these all live in the same neighborhood and need different treatments. Once the diagnosis is confirmed, most cases respond well to a structured conservative plan; corticosteroid injection or in-office aspiration is reserved for stubborn cases.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
What it feels like
Heel bursitis has a recognizable pattern. Common features:
- Aching pain at the back of the heel that worsens with activity
- Tenderness when you press directly behind the heel
- Visible swelling or a soft fluctuant lump just above the heel bone
- Pain when wearing shoes that press the back of the heel
- Pain when standing on tiptoes
- Redness or warmth over the back of the heel in more inflamed cases
- Pain in the calf or Achilles area when the inflammation has been there a while
Why it develops
Heel bursitis develops when the bursa is irritated by mechanical pressure or overuse. Common contributors:
- Starting a new high-impact exercise program
- Increasing running mileage or speed too quickly
- Shoes that rub or press the back of the heel — particularly stiff dress shoes or new athletic shoes
- Standing for long hours on hard surfaces
- Haglund's deformity — a bony prominence at the back of the heel
- Inflammatory arthritis (rheumatoid, gout)
- Tight calf and Achilles complex
- Direct trauma to the back of the heel
How we diagnose heel bursitis
The exam is the centerpiece. Your podiatrist will identify exactly where the pain is — bursitis pain is typically directly behind the heel bone, while Achilles tendonitis pain is in the tendon itself, and plantar fasciitis is underneath the heel. On-site digital X-ray is used to look for Haglund's deformity or other bony causes. Ultrasound is occasionally used to visualize the bursa directly. Most patients leave the first visit with a clear diagnosis and a written plan.
Non-surgical care
Heel bursitis usually responds well to a stepped conservative plan:
- Relative rest — back off the activity that's driving the inflammation
- Ice for 15–20 minutes after activity, multiple times daily
- Shoes with a soft heel counter or open-back styles temporarily
- Heel lifts to reduce Achilles tension
- Custom orthotics when biomechanical factors contribute
- Calf stretching and eccentric strengthening
- Anti-inflammatory medication for the acute phase
- Physical therapy for graduated return to activity
- Steroid injection used cautiously and rarely — injecting near the Achilles tendon carries a small risk of rupture
When to see a specialist
- Back-of-heel pain that has lasted more than 2 weeks and isn't improving with rest and ice
- Visible swelling or a lump at the back of the heel
- Pain that's changing how you walk
- Heel pain plus warmth or redness
- Recurring heel bursitis with each training cycle — biomechanical workup is warranted
Heel bursitis is evaluated and treated by any of our podiatrists. Sports medicine providers — Dr. Todd Galle (Tigard Oleson), Dr. Manny Moy (Milwaukie), and Dr. Magnus Schlyer (Wilsonville) — see a particularly high volume of heel and Achilles complaints.
Frequently asked questions
- Achilles TendonitisThe most commonly confused diagnosis — different anatomy, different plan
- Plantar FasciitisPain underneath the heel rather than at the back — important to distinguish
- Heel SpursA bony finding often mentioned in heel pain workups
- ArthritisInflammatory arthritis is a common driver of recurring heel bursitis