Haglund syndrome
Updates to Article Attributes
Haglund syndrome refers to the triad (Haglund triad) of:
- insertional Achilles tendinopathy
- retrocalcaneal bursitis
- Haglund deformity (i.e. posterosuperior calcaneal exostosis)
Terminology
Haglund syndrome is a painful condition of the heel and its diagnosis requires a combination with clinical and radiological findings 8. Haglund deformity can predispose and lead to Haglund syndrome, but its presence does not automatically infer Haglund syndrome.
Clinical presentation
Pain centered around the heel and the Achilles insertion. It can present both unilaterally and bilaterally. It is associated with calcaneal spurs, and the wearing of high heels (hence the colloquial term "pump-bump") or stiff-backed shoes in general.
Pathology
The Haglund deformity irritates local structures leading to a spectrum of findings depending on the chronicity of symptoms.
Radiographic features
Once suspected, weight-bearing lateral foot radiographs should be first performed to characterise bony changes, however, angle measurements and the morphology of the calcaneum correlate poorly with symptoms 8.
Plain radiograph
- prominent bursal projection of the calcaneum ("pump-bump") or Haglund deformity
- loss of the Kager triangle due to retrocalcaneal bursitis
- Achilles tendon measuring >9 mm in thickness indicating Achilles tendinopathy
- convexity of the soft tissues posterior to the Achilles tendon insertion due to superficial retro-Achilles bursitis
- Chauveaux-Liet angle >12º
MRI
- used in those with diagnosis uncertainty to better assess soft tissues
- Achilles tendinosis evidenced by focal enlargement and abnormal signal in the distal Achilles tendon
- Achilles partial thickness tear and/or Achilles insertional tendinopathy
- retrocalcaneal and/or retro-Achilles bursitis
- calcaneal bony spur best appreciated on the T1 sagittal images
- marrow oedema in the posterior calcaneal tuberosity in severe cases
US
- similar to MRI and depending on availability and referrer preference, used in those with diagnosis uncertainty to better assess soft tissues
- focal thickening and hyperaemia of the distal Achilles tendon and enthesis
- Achilles tendinopathy and/or partial thickness tear
- retrocalcaneal and/or retro-Achilles bursitis
Treatment
Physiotherapy, used in conjunction with guided corticosteroid injections into the retrocalcaneal bursa. Surgical removal of the Haglunds deformity can be performed in nonresponsive cases.
History and etymology
It was first described by Swedish orthopaedic surgeon Patrick Haglund (1870-1937) 7 in 1927 6.
Differential diagnosis
-<li><a title="Achilles tendon thickening" href="/articles/achilles-tendon-thickening">Achilles tendon thickening</a></li>- +<li><a href="/articles/achilles-tendon-thickening">Achilles tendon thickening</a></li>
Image 11 MRI (T2 fat sat) ( update )
