Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Subcalcaneal bursitis patients present with central heel pain that is more proximal and lateral than the origin of the plantar fascia. Posterior adventitial bursitis patients present with a small palpable point tender mass posterior calcaneal tuberosity. Occasionally, a small mobile sac can be palpated directly under the calcaneal tuberosity. The purpose of this study was twofold: 1) to differentiate presentation and treatment for adventitial bursitis versus other causes of heel pain; namely plantar fasciitis and insertional Achilles tendonitis and 2) to measure patient satisfaction and treatment outcomes for these pathologies. The authors hypothesized treatment using a standard protocol of offloading orthotics, padding, non-steroidal anti-inflammatory drugs (NSAIDs), ice application, and, in some cases, corticosteroid injection, would result in significant improvement in pain scores and patient satisfaction.
Methods:
To the authors’ knowledge, this is the first study addressing this topic. A retrospective chart review was performed to identify patients who were seen from January 2020 to March 2024 with diagnosis codes for enthesopathy of the foot and ankle. Demographic, previous treatment data and pretreatment Visual Analog Scale (VAS) scores were obtained from medical records. Conservative standard of care protocol included padding, offloading orthotics, icing, and NSAIDs. Of the 138 patients who met inclusion criteria, 79 patients completed the phone survey to report current VAS score, rate their treatment satisfaction and rank the effectiveness of their treatments. The primary outcome measurement was VAS improvement, with patient satisfaction as a secondary outcome.
Results:
Seventy-nine patients (22 men, 57 women) with a mean age of 58.9 were included in data analysis. After treatment, VAS scores were significantly (P < 0.0001) reduced by an average of 4.0 points, with 46 patients reporting complete resolution of symptoms. Patients with posterior bursitis (n=11; Mean VAS = -4.45) reported a greater VAS improvement as compared to patients with plantar bursitis (n=68; Mean = -4.0), but this was not statistically significant (p = 0.64). Pain reduction in the corticosteroid injection group (n=10; VAS mean = -4.4) was not statistically significant (p=0.5430) as compared to the non-injection group (VAS mean = -3.9). Conservative treatments were ranked from most (10) to least (0) effective in reducing VAS as follows: padding (Median=8), orthotics (Median=8), icing (Median=5.5), and NSAIDs (Median=5).
Conclusion:
Correct diagnosis of posterior adventitial or subcalcaneal bursitis is essential to avoid prescribing common treatments for heel pain, which can lead to worsening of pain. It is important to note, these patients were not treated with the standard of care protocol for plantar fasciitis and insertional achilles tendinitis, which includes stretching, eccentric strengthening, and ankle-foot orthosis night splint. Findings of this study support the hypothesis that treatment of posterior adventitial or subcalcaneal bursitis with a conservative standard of care protocol of offloading orthotics, padding, icing, NSAIDs, and, if needed, corticosteroid injections, provide the greatest improvement in VAS and patient satisfaction.