- Discussion:
- inflammation can be related to a Haglund deformity (postero-superior prominence - normal varient) which causes an overlying bursitis;
- prominence of the posterior superior calcaneal tuberosity contributes to inflammation of the overlying
tissues and the Achilles tendon;
- most often occurs in women and is related to shoe wear w/ rigid heels or heel counters;
- patients note posterolateral prominence and tenderness;
-
diff dx:
achilles tendinitis
- MRI:
- useful to determine if there are distinct degenerative areas within the tendon (achilles tendinosis), which
might require debridement if resection of the Haglund's deformity were indicated;
- Non Operativer Treatment:
- non operative treatment consists of heel cord stretching, change in shoe wear,
NSAIDS;
- raising the heel out of the shoe with a heel insert, shifts the contact against the heel and
often relieves symptoms;
- Operative Treatment:
- excision of the Haglund prominence can be effective in chronic cases;
- excision must be kept proximal to the achilles insertion;
- lateral approach is easier but care must be taken to avoid
sural nerve;
- medial incision may also be used;
- vertical incision is made 1 cm anterior and parallel to the medial border of the Achilles tendon, and down onto the calcaneus;
- posterior calcaneal tuberosity is removed, and the Achilles tendon is debrided and reattached using bone anchors;
- Achilles tendon is dissected subperiosteally at the insertion of the Achilles tendon (about
50% of the tendon is elevated) and the calcaneal prominence is removed;
- average size of the excised fragment is 3 cm wide, 3 cm long, and 6 mm thick;
- calcium deposits are removed from the Achilles tendon if they are present;
- patients are immobilized for four weeks;
Operative management of Haglund's deformity in the non athlete: a retrospective study.
GJ Sammarco MD et al. Foot and Ankle International. Vol 19. No 11. Nov. 1998. p 724.
Chronic retrocalcaneal bursitis treated by resection of the calcaneus. P. Angermann. Foot and Ankle. Vol 10. 1990. p 285-287.
Prominence of the calcaneus: late results of bone resection. Huber, HM. JBJS. 74-B. 1992. p 315-316.
The Achilles Tendon Insertion is Crescent-shaped: An In Vitro Anatomic Investigation
