Heel Pain While Running: Can Running Shoes Cause Retrocalcaneal Bursitis?
Athletic shoes play a much more important role in the health of the feet and ankles than many people realize. Inappropriate, worn-out, or ill-fitting sneakers—ones that aren’t adapted to a person’s biomechanics—can alter the way a person walks or runs and increase the strain on muscles, tendons, and joints.
One of the injuries that can result from this overload is retrocalcaneal bursitis, an inflammation located at the back of the heel that causes pain, limits physical activity, and even makes everyday activities such as walking or climbing stairs difficult.
Although it is common among runners and athletes, it can also affect anyone who wears inappropriate footwear or engages in repetitive activities that put pressure on the heel.
What is retrocalcaneal bursitis?
Retrocalcaneal bursitis is inflammation of one of the bursae located between the Achilles tendon and the heel bone (calcaneus).
Bursae are small sacs filled with synovial fluid whose function is to reduce friction between tendons, bones, and soft tissues during movement. When they are subjected to excessive pressure or continuous friction, they can become inflamed and cause pain.
The most common symptoms include:
- Pain in the back of the heel.
- Localized inflammation.
- Discomfort when walking or running.
- Pain when climbing stairs or standing on tiptoes.
- Sensitivity to friction from footwear.
- Stiffness after periods of rest.
In many cases, this injury may occur alongside Achilles tendinopathy, so it is important to make an accurate diagnosis.
Can athletic shoes cause bursitis?
Yes. Footwear directly influences the distribution of the forces exerted on the foot and ankle while walking or running.
When shoes do not provide adequate support or put excessive pressure on the heel, the likelihood of irritation of the retrocalcaneal bursa increases.
There is usually not a single cause, but rather a combination of various biomechanical factors and overuse.
What characteristics of footwear increase the risk?
Buttress too rigid
The heel counter is the back part of the shoe that surrounds the heel.
If it is too hard or exerts too much pressure on the Achilles tendon insertion, it can cause repetitive friction that leads to inflammation of the bursa.
This problem is particularly common in people with a bony protrusion on the back of the heel bone.
Insufficient cushioning
Shoes with poor shock absorption place a greater load on the structures of the foot and ankle.
Over time, this strain can contribute to the development of repetitive strain injuries.
Worn-out sneakers
Even if they appear to be in good condition on the outside, sneakers gradually lose their cushioning and stability.
Continuing to train in worn-out shoes alters biomechanics and increases the risk of injury.
Footwear not suited to the type of foot strike
Each person has different biomechanical characteristics.
Factors such as pronation, supination, the type of foot arch, or foot mobility can alter the distribution of pressure and contribute to the onset of pain when footwear is not appropriate.
Wrong size
Shoes that are too tight can increase friction on the heel and put more pressure on the bursa, especially during high-impact sports activities.
Who is at greater risk of developing retrocalcaneal bursitis?
Although anyone can develop it, it is more common in:
- Runners.
- Padel or tennis players.
- Hikers.
- Athletes who perform jumps or changes of direction.
- People who spend many hours walking or standing.
It can also occur in people with biomechanical abnormalities of the foot or with inflammatory conditions that predispose them to bursal involvement.
How can you tell the difference between bursitis and an Achilles tendon injury?
Pain in the back of the heel does not always have the same cause.
While bursitis affects the bursa located between the tendon and the bone, tendinopathy involves a disorder of the Achilles tendon itself.
Both conditions may share symptoms and may even occur at the same time, so a clinical examination and, in some cases, a musculoskeletal ultrasound are essential for establishing the correct diagnosis.
How can this injury be prevented?
Prevention involves reducing the strain on the heel and addressing the factors that contribute to irritation of the bursa.
Some recommendations include:
- Replace your sneakers when they no longer perform as intended.
- Wear shoes that are appropriate for the sport you’re playing.
- Choose sneakers that provide stability and comfort.
- Gradually increase the intensity of your workout.
- Strengthen the muscles of the foot, leg, and ankle.
- Maintain good mobility in the ankle and the posterior chain.
Proper training planning and biomechanical analysis, when indicated, can help prevent relapses.
How is retrocalcaneal bursitis treated?
Treatment will depend on the severity of the symptoms, how long they have been present, and whether there are any associated lesions.
In most cases, treatment begins with conservative measures such as:
- Temporary change in physical activity.
- Footwear repair.
- Therapeutic exercise.
- Specialized physical therapy.
- Treatment of Biomechanical Factors.
When these measures are not sufficient, other options may be considered, such as:
- Ultrasound-guided injections in selected cases.
- Regenerative medicine treatments when indicated.
- Interventional techniques for managing persistent pain.
The goal is not only to relieve pain, but also to treat the cause of the injury and minimize the risk of recurrence.
When should you see a specialist?
It is advisable to seek a medical evaluation when:
- The pain persists for several weeks.
- There is recurring inflammation in the heel.
- The discomfort makes it difficult to walk or play sports.
- The pain returns when I resume physical activity.
- Changing shoes does not improve the symptoms.
Early diagnosis makes it possible to distinguish bursitis from other foot and ankle conditions and to begin the most appropriate treatment before the problem becomes chronic.
A Comprehensive Approach to Pain Management at MIVI Salud
Heel pain does not always have a single cause. In many cases, mechanical, biomechanical, tendinous, and functional factors are involved and must be analyzed together.
That is why, at MIVI Salud, we take a comprehensive approach to these injuries, combining an accurate diagnosis with personalized treatments aimed not only at relieving pain, but also at restoring function and preventing future relapses.
Our team of specialists in pain management and musculoskeletal disorders works collaboratively to provide the most appropriate treatment option for each patient, ranging from conservative treatments to minimally invasive ultrasound-guided procedures when necessary.
Doctor at MIVI Sant Cugat