Ankle bursitis is treated with a combination of rest, ice, anti-inflammatory medication, and footwear changes. Most cases improve within a few weeks using these conservative measures alone. The two main types affect the back of the heel: retrocalcaneal bursitis, where the fluid-filled sac between your heel bone and Achilles tendon becomes inflamed, and subcutaneous calcaneal bursitis, where the sac between your skin and the tendon is the problem. Treatment is similar for both, though the specific location of your pain matters for choosing the right approach.
Where the Pain Comes From
Your heel has small fluid-filled sacs called bursae that act as cushions, reducing friction between bones, tendons, and skin. The most commonly affected one sits deep between your heel bone (calcaneus) and the Achilles tendon. When this bursa becomes irritated from repetitive pressure, overuse, or poorly fitting shoes, it swells and produces pain right at the back of the heel.
A second bursa sits closer to the surface, between the Achilles tendon and the skin. This one tends to flare up from direct pressure, like the rigid back of a shoe rubbing against the heel. You might notice a visible bump or redness in this area when it’s inflamed. Both types can exist at the same time, and the overlap with Achilles tendon problems is common enough that getting the right diagnosis matters before starting treatment.
How to Tell It Apart From Achilles Tendonitis
Bursitis and Achilles tendonitis cause pain in nearly the same spot, but they behave differently. Bursitis pain tends to be concentrated right where the tendon meets the heel bone, and squeezing the sides of the heel often reproduces it. The area may feel warm or look puffy. Achilles tendonitis, by contrast, typically causes pain along the tendon itself, slightly higher up from the heel, and gets worse with activities that load the tendon like running, jumping, or pushing off while walking. If your pain is worst when you press directly on the back of the heel rather than along the cord of the tendon, bursitis is the more likely culprit.
Rest and Ice in the First Week
The first step is reducing the inflammation that’s causing your pain. Stop or significantly cut back on whatever activity triggered it, whether that’s running, hiking, or wearing a particular pair of shoes. Complete immobilization isn’t necessary for most people, but continuing to push through the pain will keep the bursa irritated.
Ice is most effective early on, before chronic swelling sets in. Apply a cold pack to the back of your heel for 10 to 15 minutes at a time, and don’t go past 20 minutes per session. A thin cloth between the ice and your skin prevents frostbite. You can repeat this several times a day, especially after any activity that aggravates the area. Heat is less useful in the acute phase because it can increase swelling, but it may feel good once the initial inflammation has calmed down after several days.
Anti-Inflammatory Medication
Over-the-counter anti-inflammatory drugs like ibuprofen or naproxen can reduce both pain and swelling. Research on similar overuse conditions shows that these medications are most effective during the first 7 to 14 days. They work well for managing acute flare-ups but aren’t a long-term solution. If you’re still relying on them after two weeks, the underlying cause of the irritation likely needs to be addressed through other means.
Topical anti-inflammatory gels applied directly to the heel can also help and tend to cause fewer stomach-related side effects than oral versions. Either option is reasonable for short-term relief while you work on the mechanical factors driving the problem.
Footwear Changes and Heel Lifts
Shoes are often the biggest controllable factor in ankle bursitis. Rigid heel counters (the stiff back panel of a shoe) press directly against the inflamed bursa and keep it irritated. Switching to shoes with a softer, more flexible heel counter, or using open-backed shoes temporarily, can make a noticeable difference within days.
Heel lifts placed inside your shoes reduce the angle at which the Achilles tendon pulls on the heel bone, which takes pressure off the retrocalcaneal bursa. A 20-millimeter (roughly three-quarter inch) heel lift has been shown to significantly reduce pain during normal walking and improve symptoms after just two weeks of regular use. These are inexpensive foam or rubber inserts you place under the insole at the back of the shoe. Make sure your shoe has enough depth to accommodate the lift without cramming your heel upward against the back of the shoe, which would defeat the purpose.
If a bony prominence on your heel (sometimes called a Haglund’s deformity or “pump bump”) is contributing to the friction, padding around the bump rather than over it can help redistribute pressure.
Stretching and Strengthening
Tight calf muscles increase the load on the Achilles tendon and the bursae beneath it. Gentle calf stretches, holding for 30 seconds at a time with your knee straight and then slightly bent, target both muscles in the calf and can gradually reduce the mechanical stress on the back of your heel. Do these on a flat surface or a step edge, two to three times per day.
Eccentric calf exercises, where you slowly lower your heel below the level of a step, are a staple for Achilles-related problems and can help with bursitis that coexists with tendon irritation. Start with bodyweight only, and avoid pushing into sharp pain. The goal is gradual loading over weeks, not aggressive stretching in the first few days when inflammation is still high.
Corticosteroid Injections
If conservative treatment hasn’t worked after several weeks, a corticosteroid injection into the bursa is an option. These injections reliably reduce pain in the short term, typically within a few days, and the effect lasts up to about six weeks. Beyond six months, there’s no evidence they provide any lasting benefit for chronic cases, so they’re best thought of as a window of relief that lets you rehab more effectively.
There’s an important caution with injections near the Achilles tendon. Animal studies show that corticosteroids can weaken tendon tissue, and there are numerous case reports of Achilles tendon rupture following injection in this area. No rigorous study has quantified the exact risk in humans, but most clinicians are cautious about injecting close to the tendon. Ultrasound guidance helps place the medication precisely in the bursa and away from the tendon itself, reducing this concern.
When Surgery Becomes an Option
Surgery for ankle bursitis is uncommon and reserved for cases that haven’t responded to months of conservative care. The typical procedure is a bursectomy, which is removal of the inflamed bursa. This can be done through a traditional open incision or endoscopically through small portals, depending on what’s going on beneath the surface.
If a bony spur or prominence on the heel bone is the root cause of the friction, the surgeon will often shave it down at the same time. In rare cases where the bursa contains loose cartilage fragments (a condition called synovial chondromatosis), complete removal of both the bursa and the fragments is necessary to prevent recurrence. Recovery from bursectomy generally involves several weeks of limited weight-bearing followed by gradual return to activity, though timelines vary based on whether bone work was also performed.
What Recovery Looks Like
Most people with ankle bursitis see meaningful improvement within a few weeks of consistent conservative treatment. The key variables are how long the bursa has been inflamed before you start addressing it and whether you’ve eliminated the mechanical trigger. Someone who catches it early and switches shoes right away may feel better in a week or two. Someone who has been dealing with it for months before making changes may need six to eight weeks or longer.
Recurrence is common if the original trigger isn’t corrected. If tight shoes caused it, no amount of ice and medication will fix the problem long-term unless the footwear changes. If overtraining was the issue, a gradual return to activity with proper calf flexibility work gives the best chance of staying pain-free. Pay attention to any return of that familiar heel tenderness, because catching a flare early is far easier than treating one that’s been building for weeks.