Retrocalcaneal bursa injection is a useful therapeutic procedure for bursitis secondary to repetitive overuse disorder or rheumatoid arthritis.
After informed consent is obtained, the patient is situated in the side lying position. The lateral malleolus and the Achilles tendon are palpated. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 23- to 25-gauge needle is inserted between the lateral malleolus and the Achilles tendon perpendicular to the skin. The needle is advanced slowly to about half the thickness of the width of the Achilles tendon. After negative aspiration, a 2-mL mixture of 2 mg of triamcinolone acetonide (or equivalent) and local anesthetic is injected (Fig. 67-57).
FIGURE 67-57. Retrocalcaneal bursa injection. Approach for retrocalcaneal bursa aspiration and injection.
This disorder may be seen in runners as they increase mileage early in the season or from an improperly fitting running shoe.
Corticosteroids should not be injected if there is any suspicion that the bursa is infected. If the fluid appears infected, then it should be sent for culture and sensitivity and the patient treated appropriately for the infection.