Haglund syndrome

Last revised by Joshua Yap on 9 Oct 2023

Haglund syndrome refers to the triad (Haglund triad) of:

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Haglund syndrome is a painful condition of the heel and its diagnosis requires a combination of clinical and radiological findings 8. Haglund deformity can predispose and lead to Haglund syndrome, but its presence does not automatically infer Haglund syndrome.

Patients present with pain centered around the heel and the Achilles insertion. Haglund syndrome 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.

The Haglund deformity irritates local structures leading to a spectrum of findings depending on the chronicity of symptoms. 

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Once suspected, weight-bearing lateral foot radiographs should be first performed to characterize bony changes, however, angle measurements and the morphology of the calcaneum correlate poorly with symptoms 8.  

  • 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

Ultrasound findings are similar to MRI and depend on availability and referrer preference. It is typically used for patients with diagnostic uncertainty to better assess soft tissues. Findings include:

  • focal thickening and hyperemia of the distal Achilles tendon and enthesis

  • Achilles tendinopathy and/or partial thickness tear

  • retrocalcaneal and/or retro-Achilles bursitis 

MRI is also used for patients with diagnotic uncertainty to better assess soft tissues. Findings include:

  • 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 edema in the posterior calcaneal tuberosity in severe cases

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Treatment is typically physiotherapy in conjunction with guided corticosteroid injections into the retrocalcaneal bursa. Surgical removal of the Haglund deformity can be performed in non-responsive cases.

It was first described by Swedish orthopedic surgeon Patrick Haglund (1870-1937) 7 in 1927 6.

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