Marcio Luis Duarte1,2*, Andre de Queiroz Pereira da Silva1, Jose Luiz Masson de Almeida Prado1 and Marcelo de Queiroz Pereira da Silva1
Received: September 26, 2019; Published: October 03, 2019
Corresponding author: Marcio Luis Duarte, WEBIMAGEM, Avenida Marques de Sao Vicente 446, Sao Paulo, Brazil
Haglund syndrome is a cause of posterior heel pain and occurs commonly in adolescent girls who wear high heels with restrictive heel counters and may occur in people with rheumatoid arthritis. Is characterized clinically by thickening of the soft tissues at the Achilles tendon insertion or a painful “pump bump” and retrocalcaneal bursitis, Achilles tendinitis, and a prominent posterosuperior calcaneal border or bursal projection. We report a case of a 59 years-old woman with bilateral Haglund syndrome which did not needed surgical treatment, being the conservative treatment enough to improve the patient’s quality of life.
Keywords: Calcaneus; Magnetic resonance imaging; Foot diseases
Haglund syndrome is a cause of posterior heel pain and was first described by Patrick Haglund, in 1928, to occur in patients who had a prominence of the posterosuperior surface of the calcaneus . It occurs commonly in adolescent girls who wear high heels with restrictive heel counters and may occur in people with rheumatoid arthritis . Haglund syndrome has also been termed “pump bump,” “winter heel,” “knobby heels,” “calcaneal altus,” “highbrow heels,” and “cucumber heels” . Haglund syndrome is characterized clinically by thickening of the soft tissues at the Achilles tendon insertion or a painful “pump bump” and retrocalcaneal bursitis, Achilles tendinitis, and a prominent posterosuperior calcaneal border or bursal projection [1-4].
Figure 1: Sagittal section MRI in T1 sequence in A and T2 STIR sequence in B of the right ankle demonstrating posterior calcaneal spur (red arrow), liquid in retrocalcaneal bursa (blue arrow), liquid in subcutaneous calcaneous bursa (orange arrow), and calcaneal tendinopathy (green arrow).
Figure 2: Sagittal section MRI in T1 sequence in A and T2 STIR sequence in B of the left ankle demonstrating posterior calcaneal spur (red arrow), liquid in retrocalcaneal bursa (blue arrow), liquid in subcutaneous calcaneous bursa (orange arrow), and calcaneal tendinopathy (green arrow).
59 years-old woman with pain and swelling in both feet for four months that get worse when use slippers and when she wake up and put her feet in the floor for the first time in the day. The patient denies other complaints and surgeries. At physical examination refers pain at the palpation of in the posterior and inferior regions of the ankle. The Magnetic Resonance Imaging (MRI) demonstrates posterior and plantar calcaneal spurs, liquid in retrocalcaneal and subcutaneous calcaneous bursa, and calcaneal tendon with heterogeneous signal and thickened (1.4cm at left and 1.2cm at right), markedly in their insertion with adjacent bone edema (Figures 1 & 2). The set of findings are compatible with Haglund syndrome. The patient started conservative treatment with non-steroidal anti-inflammatories, change of footwear and physiotherapy, presenting a good response, not requiring surgery.
Haglund syndrome is caused by mechanically induced inflammation of the Achilles tendon and its bursa, from abnormally high pressure between the bursal projection of the calcaneus, the Achilles tendon, and the bursa [1,5]. Patients with bursitis have erythema and swelling over the bursa and tenderness to direct palpation  besides pain with dorsiflexion of the foot . Clinically, by physical examination alone, it may be difficult to distinguish Haglund’s syndrome from other causes of hindfoot pain such as Reiter’s disease, rheumatoid arthritis, or isolated local conditions such as superficial tendon Achilles bursitis secondary to poor shoe fit . Plain radiograph in a lateral standing position is useful to assess the presence of a prominent bursal projection of the calcaneum, the Haglund deformity . Loss of a lucent retrocalcaneal recess is an important indication of underlying retrocalcaneal bursitis . The Achilles tendon is swollen, and dystrophic calcifications may also be seen .
MRI may be required for ambiguous or clinically equivocal cases . The cardinal soft tissue abnormalities, namely Achilles tendinopathy, and retrocalcaneal and retroachilles bursitis are more easily and directly depicted by MRI . The detection of marrow oedema within the prominent bursal projection is likely to support the repetitive mechanical compression and inflammation as the pathological mechanism in this condition . Treatment of Haglund deformity, with or without bursitis, targets decreasing the pressure and inflammation with openheeled shoes, anti-inflammatory or analgesic medications, and corticosteroid injections . Physical therapy may also help reduce pain. In recalcitrant cases, surgery to remove the Haglund deformity may be necessary .
The nonsurgical treatment, combined with modifications in daily shoe wear, is an appropriate initial treatment for pain relief of Haglund’s syndrome . Using ultrasound guidance to inject the retrocalcaneal bursa is a simple, reliable method of ensuring accurate delivery of medication into the bursa and avoiding intratendinous injection .
Bio chemistryUniversity of Texas Medical Branch, USA
Department of Criminal JusticeLiberty University, USA
Department of PsychiatryUniversity of Kentucky, USA
Department of MedicineGally International Biomedical Research & Consulting LLC, USA
Department of Urbanisation and AgriculturalMontreal university, USA
Oral & Maxillofacial PathologyNew York University, USA
Gastroenterology and HepatologyUniversity of Alabama, UK
Department of MedicineUniversities of Bradford, UK
OncologyCirculogene Theranostics, England
Radiation ChemistryNational University of Mexico, USA
Analytical ChemistryWentworth Institute of Technology, USA
Minimally Invasive SurgeryMercer University school of Medicine, USA
Pediatric DentistryUniversity of Athens , Greece
The annual scholar awards from Lupine Publishers honor a selected number Read More...
We know the financial complexity of Individual read more...
The annual scholar awards from Lupine Publishers honor a selected number read more...