What Is Heel Bursitis?
Heel bursitis is inflammation of one or both of the fluid-filled sacs (bursae) located at the back of the heel. The deeper 
one — called the retrocalcaneal bursa — sits between your Achilles tendon and your heel bone. The shallower one sits just under the skin at the very back of your heel. When either becomes irritated and swollen, the result is pain, stiffness, and tenderness that makes every step feel like a reminder that something's wrong.
Here's what most people don't realize: you actually have two separate bursae at the back of your heel, and where your pain is located tells me a lot about what we're dealing with before I even take an X-ray. The retrocalcaneal bursa — the deeper one — gets compressed every time your ankle bends upward. Walking upstairs, hiking an incline, even stepping off a curb. That's why this type of bursitis re-aggravates so reliably — your ankle can't avoid dorsiflexion, and the bursa can't catch a break.
What makes chronic cases so stubborn is what happens after the initial inflammation sets in. Your body launched a healing response to protect the bursa — but that response stalled before it converted into actual tissue repair. Think of it like a construction crew that showed up, set up their equipment, and then never finished the job. The crew is still there. The inflammation is still active. But the real work of healing never happened. That stalled cycle is why people with long-standing heel bursitis often feel like they've tried everything and gotten nowhere — they have tried everything, but nothing addressed the reason the healing response broke down in the first place.
And there's one more thing I see people get wrong all the time: heel bursitis frequently occurs alongside insertional Achilles tendinopathy — degeneration where the Achilles attaches to the heel bone. These two conditions share the same anatomical neighborhood, and treating one without recognizing the other is one of the main reasons back-of-heel pain becomes a months-long problem instead of a weeks-long one.
What Causes Heel Bursitis?
The short answer: repetitive compression. Every time your ankle bends upward — what we call dorsiflexion — the retrocalcaneal bursa gets squeezed between the Achilles tendon and the calcaneus, your heel bone. Do that thousands of times a day across weeks or months, and the bursa eventually responds with inflammation. But the specific trigger driving that compression varies from person to person, and identifying yours matters enormously for how we treat it.
Footwear is the number one culprit I see in my office. Shoes with rigid, enclosed heel counters — dress shoes, certain running shoes fresh out of the box, stiff hiking boots — press directly against the subcutaneous calcaneal bursa, the shallower one sitting just under your skin. If your shoes dig into the back of your heel, you're not just experiencing irritation. You're mechanically compressing that bursa with every step. Runners sometimes call this a "pump bump," and it's exactly as straightforward as it sounds.
There's another structural cause that gets missed more than it should: Haglund's deformity. This is a bony prominence that develops on the back of the heel bone itself — a permanent internal irritant that no amount of footwear changes or stretching will eliminate. I've seen people do everything right and still keep relapsing. Haglund's is often why. If you've had multiple rounds of treatment without lasting relief, this is one of the first things I look for on X-ray.
I see a noticeable spike in heel bursitis cases every fall in Houston — when temperatures finally drop and runners who've been on the treadmill all summer suddenly ramp up their mileage on Memorial Park trails. The bursa can't adapt to a sudden jump in load that fast. Systemic conditions like rheumatoid arthritis, gout, and psoriatic arthritis can also drive bursitis — and if one of these is involved, local treatment alone won't hold long-term without managing the underlying disease.
One misconception I want to clear up before we go further: a lot of people assume this is the same as plantar fasciitis because both cause heel pain. They're not. Plantar fasciitis is pain at the bottom of the heel where the fascia attaches. Heel bursitis is pain at the back of the heel, closer to your Achilles. I've seen people treat the wrong thing for months. If you're a runner dealing with heel pain, getting that distinction right from the start changes everything about your recovery.
How a Houston Podiatrist Treats Heel Bursitis
My approach to heel bursitis starts with one question: what do you want to get back to? A marathon runner and someone who just wants to walk the dog without wincing are both dealing with the same condition — but their treatment plans aren't identical. I listen first. Then we build a plan together that moves from the least invasive option that makes sense for your case, all the way through to surgery if it ever truly becomes necessary.
Level 1: Lifestyle Modification
Sometimes the single most important thing you can do has nothing to do with a procedure. It starts with what's on your feet. Swapping rigid, enclosed heel counters for open-backed shoes or footwear with an Achilles notch removes the direct mechanical pressure that's been re-aggravating your bursa every single day. I also recommend a 3/8-inch heel lift inside the shoe — a simple insert that reduces the tension the Achilles puts on the retrocalcaneal bursa with every step. No barefoot walking on hard floors, and a deliberate reduction in the activities that load your ankle into dorsiflexion: stairs, inclines, and running are the big three.
This level won't heal the bursa. But it stops the re-injury cycle so that other treatments can actually work. Most people see meaningful symptom reduction within 2–3 weeks when they strictly remove the primary aggravator. If you're not seeing improvement after three weeks of real modification, that's when we escalate — because waiting past that point is how acute bursitis becomes a chronic problem.
Level 2: At-Home Care
For some people, combining lifestyle changes with targeted at-home care is enough to get over the hump. Ice — not heat — applied directly to the back of the heel for 15–20 minutes, two to three times daily, is the right call for an inflamed bursa. Heat feels good momentarily but increases blood flow to an area that's already hyperemic, and it can temporarily worsen swelling. NSAIDs like ibuprofen or naproxen, taken consistently with food for 7–14 days, can help bring the inflammatory response down enough for the bursa to begin recovering.
Here's where I want to be direct about something: aggressive Achilles stretching is the wrong move during active bursitis. I know that sounds counterintuitive — stretching is the universal recommendation for any kind of heel pain. But forceful dorsiflexion compresses the retrocalcaneal bursa between the tendon and the heel bone. If you've been faithfully doing wall stretches twice a day and wondering why you're not getting better, this is very likely why. Gentle ankle circles, yes. Aggressive Achilles loading, not yet. That protocol changes once the inflammation is under control — but doing it too soon is one of the most common reasons people plateau.
Level 3: Conservative In-Office Treatment
When at-home care isn't enough — or when your symptoms are severe enough that you shouldn't be managing this on your own — there's a lot we can do in the office before anyone starts talking about surgery.
Custom orthotics ($700) are often the foundation of long-term management for heel bursitis. Think of them like 
eyeglasses for your feet: while you're wearing them, they're compensating for the exact mechanical loading pattern that drove the bursitis in the first place. If Haglund's deformity is present, a custom heel cup can offload the prominent bone directly — something no over-the-counter insert is designed to do. I fabricate these after a full gait evaluation and 3D foot scan, so what you're getting is built for your foot, not a generic approximation.
Cortisone injection ($120) is available, and I want to be transparent about when and why I use it — and why I'm more cautious here than I am with cortisone elsewhere in the body. A corticosteroid injection can rapidly reduce inflammation in the retrocalcaneal bursa, and in acute cases where pain is severe, it has a role. But the Achilles tendon runs immediately adjacent to this injection site, and there is documented risk of tendon weakening and potential rupture with peritendinous corticosteroid injection.¹ I won't judge you if this is the first time you're hearing this — most doctors don't explain it. But you deserve to know what you're agreeing to. If cortisone is appropriate for your case, I'll explain exactly why, and we'll limit it to one injection followed by a period of restricted Achilles loading. It's not a default first step here.
Physical therapy — specifically an eccentric calf loading protocol, not passive stretching — is effective for rebuilding tendon and bursal tolerance once inflammation is controlled.² Therapeutic ultrasound can help address bursal swelling directly. If the bursa is markedly distended, bursal aspiration (draining the excess fluid with a needle) provides immediate mechanical relief and allows other treatments to reach the tissue more effectively. If your bursitis is relatively new and uncomplicated, 60–70% of people resolve within 8–12 weeks at this level. But if you've been dealing with this for six months or more, that's a different story — and it needs a different conversation.
Level 4: Regenerative Medicine — The Third Option
In most medical offices, the progression goes: cortisone didn't work → surgery. But there's a third option most people never hear about until they end up sitting in my chair — and for chronic heel bursitis, it's often what finally breaks the cycle.
Shockwave therapy ($300 per session; $750 for a package of 3) is a treatment I use on my own heel pain. It works by delivering acoustic pressure waves into the tissue around the bursa and Achilles insertion — think of it like aerating a compacted lawn. The waves break up scar tissue, stimulate the formation of new blood vessels, and restart a healing response that has stalled out. For chronic bursitis, the tissue is stuck in that failed healing loop — the construction crew showed up and never finished the job. Shockwave sends them back to work. Treatment is three sessions, once weekly, 10–15 minutes each. 82% of people find their pain resolved after completing the full protocol.³
Platelet-rich plasma (PRP) therapy ($850) is what I call liquid gold for healing. We draw a small amount of your own blood, spin it in a centrifuge to concentrate the platelets and growth factors, then inject that concentrated healing solution precisely into the bursa and Achilles insertion zone under ultrasound guidance. It doesn't mask pain the way cortisone does — it tells your body's repair mechanisms to actually rebuild the damaged tissue. 70–80% of people with chronic tendon and bursal problems see significant improvement with PRP alone.⁴
My preferred protocol for chronic or treatment-resistant heel bursitis — especially when Achilles co-involvement is present — is the Combined PRP + Shockwave Protocol ($1,600). These two regenerative medicine options work synergistically in a way that neither does alone. It's like planting seeds in a garden: PRP provides the seeds — the concentrated growth factors delivered directly to the injured tissue. Shockwave prepares the soil — creating the optimal biological environment for those growth factors to activate and do their work. Together, the combined protocol produces an 85–95% success rate for chronic conditions. Most people begin noticing improvement within 2–4 weeks. Full benefit often isn't apparent until 3–6 months out — but unlike cortisone, the results tend to last. Treatment runs over three weeks: three shockwave sessions plus one PRP injection. You continue your daily activities throughout. No cast. No crutches. No weeks off work.
If you're dealing with persistent inflammation alongside your bursitis, I may also bring in red light therapy for inflammation as an adjunctive option ($39 per session; $180 for a package of 6). It's not a standalone treatment, but it supports the overall healing environment — and when you're managing both bursal and tendon involvement at once, every tool that reduces background inflammation counts. A note on cost: shockwave and PRP aren't covered by most insurance plans, including Medicare. Most people find the total investment significantly less than the cumulative cost of repeated cortisone injections, extended PT co-pays, and — if things get that far — surgery and recovery.
Level 5: Surgery — When It's Actually Necessary
Look, I know foot surgery sounds scary. But when it's genuinely indicated — after 6–12 months of structured conservative and regenerative treatment hasn't resolved the condition — the procedure for heel bursitis is one of the more straightforward ones I perform.
The surgery is called a bursectomy, and it involves removing the inflamed bursa sac. When Haglund's deformity is present — and it often is in persistent cases — I remove the bony prominence at the same time. If there's significant co-existing Achilles insertional tendinopathy, I'll debride the degenerated tendon tissue simultaneously. Getting everything in one procedure produces far better long-term outcomes than going back in later.
Recovery is measured and progressive: non-weight-bearing in a surgical boot for the first two weeks, then protected weight-bearing as the incision heals, with physical therapy beginning around weeks 4–8. Most people are back to full activity within 2–3 months. Athletes with high-impact sport demands may need 3–4 months. Patient satisfaction after properly indicated bursectomy with concurrent Haglund's resection exceeds 90%.⁵
Here's what I want you to hold onto: the overwhelming majority of heel bursitis cases — well over 90% — never reach this point. When the condition is diagnosed accurately and treated through the right progression, surgical treatment simply isn't where most people end up.
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What to Expect at Your Houston Podiatry Appointment
When you come in, I'll start by asking what you want to get back to — not just what hurts. That question matters, because it shapes everything that follows. If you want to run a half marathon, that's a different conversation than if you just want to walk the dog without wincing by the end of the block. Once I understand your goal, I'll examine both bursa locations directly: I'll palpate each side of the Achilles insertion and put your ankle through a dorsiflexion stress test to confirm which structure is involved and how reactive it is. That combination — where it hurts and what makes it worse — tells me more than an imaging report often does.
From there, I'll order the imaging that your specific case actually needs. Most people get an X-ray, which lets me check for Haglund's deformity and any bony heel spurs that may be contributing. If I suspect significant bursal distension, I'll use diagnostic ultrasound to quantify what we're dealing with in real time, right in the office. If there's any question about Achilles co-involvement that the physical exam doesn't resolve clearly, I may recommend an MRI — but I try not to order imaging for its own sake. You'll leave your first visit with a clear picture of what's happening, not a list of tests to schedule somewhere else.
Then we'll talk about where you are in the timeline and what that means for where we start. If you've had this for less than six weeks, we start differently than if it's been grinding along for eight months. I'll give you a realistic forecast at your first visit — not a vague "it depends," but an honest assessment of what to expect and when. If you're a diabetic patient managing heel pain, that conversation also includes a close look at wound risk and circulation — because bursitis in that context carries different stakes and needs earlier, more aggressive management. Dr. Andrew Schneider has treated this condition for over 25 years, and I'd rather give you an accurate picture upfront than let you leave with false optimism. Either way, I need to see you — whether your pain started last week or you've been managing it for a year. There's a clear path forward, and it starts with one visit. Schedule a visit and we'll figure it out together.
