Donte DiVincenzo – Bilateral Heel Bursitis

The Bucks rookie will miss the remainder of the regular season and playoffs to recover from his ‘bilateral heel bursitis’ which has sidelined him for all but five games in 2019. DiVincenzo is expected to make a full recovery in the offseason.

The 17th pick in the 2018 NBA draft has been in and out of the Bucks’ rotation due to this injury. Some sources have reported that he may have undergone a biologic injection to help his symptoms – it’s unclear if this procedure has occurred yet but the Bucks’ medical team has reported that rest and rehabilitation will be the best course to ensure his return next season.

Bilateral heel bursitis refers to an injury of one of the bursae on both feet concurrently. Bursa are small fluid-filled sacs that are found in many parts of the body and reduce friction mostly between soft tissue structures (e.g. muscles & tendons) and bone. Bursitis typically refers to an inflammatory irritation of a bursa which can cause pain and symptoms which aggravated by low-load movements (think raising your arm up or lifting your heels).

Of the two main bursae located at the heel, it’s likely that DiVincenzo is currently out of action with the more common bursitis of the retrocalcaneal bursae. Retrocalcaneal bursitis is generally not an isolated condition and is reported to often occur with insertional Achilles tendinopathy (overuse injury of the Achilles tendon where the pain is localised at its attachment on the heel). Athletes typically have pain at the back of the heel with activities such as heel raises (think shooting a jump shot) or end of range dorsiflexion (jumping) where compression increases irritation to the bursae.

Compression in retrocalcaneal bursitis can develop from a prominent calcaneus which predisposes it to mechanical irritation of the bursa. This irritation also causes excess fibrocartilage (strong fibrous and cartilage tissue) to develop on both the sides surrounding the bursa. In the dorsiflexed foot position, the fibrocartilage thickens on the bone and causes excessive compression which leads to heel pain.

There are a number of ways that retrocalcaneal bursitis can be rehabilitated. If there is involvement of the Achilles tendon in DiVincenzo’s pathology, treatment will include a tendon management program to reduce compression on the bursae. The biologic injection, which is most likely a corticosteroid injection performed under ultrasound guidance, will be helpful to relieving his symptoms but one study has reported that there is an increased rupture of Achilles tendon rupture. In the case that all conservative treatment for the Bucks’ guard fails, he will have to undergo surgery to remove the bursa and any associated bony prominences that could be linked to his pathology – this seems unlikely to occur at present.

Sources:
Brukner & Khan, 2017. Clinical Sports Medicine 5th ed

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