Anterior Achilles Tendon Bursitis

Also Know As Alberts Disease, Retromalleolar Bursitis

Anterior Achilles Tendon Bursitis

Anterior Achilles tendon bursitis, also known as Albert’s disease and Retromellaeolar bursitis, is an inflammation of the fluid-filled sac or bursa in front of the attachment of the Achilles tendon to the heel bone (calcaneus).

Pathophysiology

The Achilles tendon is the tendon that is attaches the muscles of the calf to the heel bone or calcaneus.  Repeated irritation in this region may lead to spur formation, resulting in bursitis.  Any condition that might cause excessive strain on the Achilles tendon can cause this condition.  It can be due to trauma from poorly fitting shoes or arthritis (eg, gout or rheumatoid arthritis).

Clinical Features

The most common symptoms are that of inflammation around the heel, such as pain, warmth, and swelling.  The swelling may initially be localized in front of the Achilles tendon but may extend to the sides as it progresses.  There may be difficulty walking and wearing shoes.  The symptoms tend to develop rapidly if associated with gout or trauma; otherwise, they tend to progress slowly.

Diagnosis

Radiographs are used to exclude a fracture of the heel bone and erosive bone changes to the calcaneus which is characteristic of chronic rheumatoid arthritis.

Treatment

Early treatment includes rest, warm or cool compress, and pain medications.  Injection with steroids and local anesthesthetics can alleviate the inflammation.  If conservative measures fail, surgery can be an option wherein part of the heel bone will be removed. 

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Transcutaneous Electrical Neuromuscular Stimulation:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation  (Available evidence does not support claims that TENS can help to treat Bursitis in any way)

Grade of Evidence: low quality of evidence

* www.gradeworkinggroup.org

Public Discussion