Dr. Silverman was recently asked to comment on the treatment options and costs involved for addressing Achilles bursitis. Below, he explains the condition and discusses options for those suffering from Achilles bursitis. As always, if you have a question for Dr. Silverman, feel free to submit a question here.
“What type of treatment do you do for Achilles bursitis? What are the typical costs involved? Basically I have heel pain on the back of my heel after running or jumping, less pain but some after biking. Feels worse right after waking up in the morning and then gets better as the day goes on. I have a high deductible with Blue Cross Blue Shield.”
Thanks for your question! I’ll answer all parts of your question, but first I just want to quickly talk about symptoms of Achilles bursitis.
Diagnosing Achilles Bursitis
Achilles bursitis or Insertional Achilles tendinitis is diagnosed by posterior heel pain. The pain is aggravated by running and other activities that stress the Achilles tendon. Inflammation begins behind the Calcaneus bone prominence known as the Haglund’s Process. To prevent damage to the Achilles, the retro-calcaneal bursa swells. When this is chronic, the bursitis turns to inflammation and eventually, in a manner up for debate as to how, progresses to insertional Achilles tendon tearing. This tearing progresses to calcification and functional tears (the scar tissue that forms is lengthened and dysfunctional).
Treating Achilles Bursitis
Non-surgical management is often attempted regardless of stage of the condition. A heel lift prevents ankle dorsiflexion and may allow for resolution of the bursitis. A cast or a cast boot will relieve pressure on the degenerative tearing, and in some circumstances allow for strengthening of the tissue to tolerate normal stress. Physical therapy can be helpful by modalities such as heat, ultrasound, frictional massage, stretching and eccentric strengthening exercises. Sometimes, very bright physical therapists pick up gait and functional abnormalities that contributed to development of the condition and can work to re-train you to function better.
More often, if scar tissue has formed, patients must accept a decrease in intense, chronic activity to prevent the pain from returning. Some patients will accept this restriction. Others will not, and they opt for surgery. Since this is a functional problem, insurance coverage has not been a problem.
Procedural Costs
At this point, a doctor will order more tests to be done. Most commonly, an MRI is performed which provides information about the status of the tendon and can determine the location of maximum tendon damage and permanent tendon damage. Calcifications can be mapped similarly. An MRI costs at least $1,500.
We use an Ultrasound technology to evaluate the entire Achilles tendon. The Ultrasound is a significant cost savings, as it costs less than $100 and provides the same necessary information. In fact, an MRI can pick up other information about related problems in the foot and ankle.
Surgery is variable. Age, amount of degeneration, activity level, location of calcification among other factors determine which set of procedures is the right choice. Surgery includes a facility fee, an anesthesiologist evaluation, and management and post-operative physical therapy. This is expensive and often exceeds most deductibles.
I hope this information was helpful, and please let me know if you have any further questions.