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# Heel bursae

The heel bursae are two fluid sacs at the back of the heel, one in front of and one behind the Achilles tendon.

Official name: Subtendinous calcaneal bursa

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## What it is

Two small fluid sacs at the back of the heel: one between the Achilles tendon and the heel bone, and one between the tendon and the skin.

## What it does

Reduce friction so the tendon glides over the bone and the skin moves freely.

## Key points

- Haglund syndrome: retrocalcaneal bursitis, insertional Achilles tendinopathy and a prominent posterosuperior calcaneus occurring together
- Retrocalcaneal bursitis and Achilles enthesitis are typical of spondyloarthritis and reactive arthritis
- The retrocalcaneal bursa fills the wedge between the Achilles tendon and the calcaneus, under Kager's fat pad

## Key facts

**Where**
Retrocalcaneal: between Achilles tendon and upper posterior calcaneus; subcutaneous: between skin and tendon

**Function**
Reduce friction at Achilles insertion; subcutaneous bursa irritated by the heel of shoes

## Relations

**Superficial**
Subcutaneous calcaneal bursa: between the [skin](https://durgical.com/en/anatomy/skin/) and the back of the [Achilles tendon](https://durgical.com/en/anatomy/calcaneal-tendon/) near its insertion, under the heel counter of the shoe

**Deep**
Retrocalcaneal bursa: between the deep surface of the Achilles tendon and the posterosuperior [calcaneus](https://durgical.com/en/anatomy/calcaneus/), capped above by Kager's fat pad

**Below**
Achilles insertion on the middle part of the back of the calcaneus

## How to find it

Lying face down with the feet over the end of the couch, the retrocalcaneal bursa lies in the soft hollows on both sides of the Achilles tendon just above its insertion. The subcutaneous bursa is a swelling directly behind the tendon at shoe level.

## Examination

- Two-finger squeeze test: pressing from both sides just in front of the Achilles tendon, above the calcaneus, is painful in retrocalcaneal bursitis

## On imaging

A lateral radiograph normally shows a sharp, fat-filled retrocalcaneal recess; a filled bursa blurs it, and a prominent posterosuperior calcaneus may be seen. Ultrasound and MRI show bursal fluid, tendon thickening and bone marrow oedema.

## Common problems

- Bursitis: painful swelling at the back of the heel, often from shoes rubbing or a bony bump on the heel (Haglund's deformity).

## Clinical notes

- Surgery for resistant Haglund syndrome removes the bursa and the bony prominence while protecting the Achilles insertion
- Injection into the retrocalcaneal bursa carries a recognised risk to the nearby Achilles tendon
- The [sural nerve](https://durgical.com/en/anatomy/sural-nerve/) runs along the lateral border of the Achilles tendon and can be injured in lateral heel approaches

## Development

The retrocalcaneal bursa is a constant synovial bursa already present in the fetus; the subcutaneous bursa behind the Achilles tendon is often acquired (adventitious), forming where a stiff shoe counter rubs, as over a 'pump bump'.

## Related conditions

- [Achilles tendon rupture](https://durgical.com/en/conditions/achilles-tendon-rupture/)

## Test yourself

Think of the answer, then tap the question to see it.

## Where are the two heel bursae located?

Retrocalcaneal: between the Achilles tendon and the upper posterior calcaneus; subcutaneous: between the skin and the tendon.

## What triad makes up Haglund syndrome?

Retrocalcaneal bursitis, insertional Achilles tendinopathy and a prominent posterosuperior calcaneus.

## Which test is painful in retrocalcaneal bursitis?

The two-finger squeeze test: pressing from both sides just in front of the Achilles tendon, above the calcaneus.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
bursa subtendinea calcanea; bursa subcutanea calcanea TA2 2753

**Official Spanish (DeCS)**
Bolsas subtendinosa (retrocalcánea) y subcutánea del calcáneo DeCS D002061

**English (TA2)**
Subtendinous calcaneal bursa

**Also called**
bursa of calcaneal tendon · bursa of tendo calcaneus · retrocalcaneal bursa · bursa tendinis Achillis · bursa tendinis musculi tricipitis surae

## Related

- [Achilles tendon](https://durgical.com/en/anatomy/calcaneal-tendon/)
- [Calcaneus](https://durgical.com/en/anatomy/calcaneus/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=2094&filter=ths_termall&q=Bolsa%20Sinovial); [Anatomy, Bony Pelvis and Lower Limb: Achilles Tendon](https://www.ncbi.nlm.nih.gov/books/NBK499917/); [Anatomy, Skin Bursa](https://www.ncbi.nlm.nih.gov/books/NBK554438/).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/subtendinous-calcaneal-bursa/