CASE 54
By: Dr. Subramaniyan Ramanathan MD. and Dr. Mahomud Alheidous.
HISTORY: 36-year-old female with heel pain bilaterally.
What are your findings?
What is the differential diagnosis?
What are the causes?
FINDINGS:
Plain radiographs of the right and left ankle laterally demonstrate Bony prominence seen on postero-superior aspect of calcaneal tuberosity. In addition, there is loss of Kager’s triangle with suspicion of thickening of the Achilles tendon and convexities anterior and posterior to the calcaneum [pump bump]. An abnormal Chauveaux–Liet angle is seen.
MRI with intravenous gadolinium demonstrate focal enlargement of the Achilles tendon insertion. Retrocalcaneal and retro-Achilles bursal collection seen. Marrow edema is also identified at the posterior calcaneal tuberosity. Avid enhancement is also demonstrated at these inflamed areas.
DIAGNOSIS:
Haglund’s syndrome.
PEARLS AND DISCUSSION:
To some extent hereditary plays a role in Haglund’s deformity. As some people inherit this type of foot structure that makes them prone to developing this condition. Also, ladies with high arches and high heels contribute to this problem. A tight Achilles tendon can play a remarkable role in Haglund’s deformity causing pain by compressing on the tendon inflamed bursa.
Nonsurgical treatment of Haglund’s deformity is to reduce inflammation of the bursa. This can be achieved by removal of the problem by walking without shoes. Nonsteroidal anti-inflammatory drugs. Ice, or shoe modification. Furthermore, percutaneous corticosteroid injection under fluoroscopic or ultrasound guidance can provide help in reducing the inflammation.
FURTHER READING:
Chauveaux D, Liet P, Huec J et-al. A new radiologic measurement for the diagnosis of Haglund's deformity. Surg Radiol Anat. 1991;13 (1): 39-44.
Rosenberg ZS, Beltran J, Bencardino JT. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics. 2000;20 Spec No (suppl 1): S153-79.
Reinherz RP, Smith BA, Henning KE. Understanding the pathologic Haglund's deformity. J Foot Surg. 1991;29 (5): 432-5.
