With two bursae located within the heel, the retrocalcaneal bursa located between the Achilles tendon and the calcaneus (heel bone) and the subcutaneous calcaneal bursa located between the Achilles tendon and the skin, there are a variety of factors that can cause an inflammation of these areas. Both of these are on the back of the heel. This is where most heel counters in shoes touch. Pressure from a shoe is a primary paint point for many.

Causes vary by individual case, but bursitis of the heel often occurs amongst athletes due to repetitive training and trauma. In other cases, poorly fitting or tight shoes can cause unnecessary pressure around these areas of the heel. Those who are running, jumping, walking, or frequently standing might also suffer from this type of inflammation. Although somewhat uncommon, bursitis of the heel can also occur through a bacterial infection (septic bursitis in the heel), generally caused by bacteria entering through a cut or blister. This septic bursitis can make the skin at the back of the heel feel hot and can possibly cause a fever or chills in the patient. This bacterial infection, like most others, can be treated via oral antibiotics.

The most common cause by far is the same scourge that is responsible for most of our ailments; it is chronic low-grade inflammation. In addition, deposits of abnormal proteins at the tendon near its bony insertion site contribute to pain and bursal inflammation. These proteins are called advanced glycation end products and form when excess sugar comes in contact with the proteins found in tendons. Over time, the AGE deposition and the inflammation leads to a dysfunction, painful tendon with an inflamed bursa.