Can Haglund's Syndrome Be Misdiagnosed as Low Back Pain? Findings from a Case Report in Physical Therapy Direct
Filippo Maselli1,2, Lorenzo Storari1, Valerio Barbari1
1Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova-Campus of Savona, 17100 Savona, Italy.
Insights
Haglund's syndrome (HS), a heel condition, can be challenging to diagnose. Physical therapists play a key role in identifying HS and ensuring patients receive appropriate orthopedic care for effective pain management.
Area of Science:
- Orthopedics
- Sports Medicine
- Physical Therapy
Background:
- Haglund's syndrome (HS) involves calcaneal exostosis, Achilles tendinopathy, and retrocalcaneal bursitis.
- Accurate diagnosis of HS is complicated by potential concurrent conditions.
- Musculoskeletal assessment and differential diagnosis remain challenging for HS.
Observation:
- A 41-year-old male runner presented with persistent heel pain radiating to the leg and lumbopelvic region.
- Initial treatment for low back pain was ineffective.
- Self-referral to a physical therapist (PT) was prompted by intense heel pain.
Findings:
- PT examination and patient interview led to accurate Haglund's syndrome diagnosis.
- The patient received a subsequent orthopedic referral.
- One-year follow-up showed the patient running marathons without pain.
Implications:
- Physical therapists in direct access settings are crucial for primary musculoskeletal care.
- PTs can effectively identify conditions requiring further medical or surgical intervention.
- This case underscores the importance of PT expertise in diagnosing and managing complex musculoskeletal issues like Haglund's syndrome.
Abstract:
Background: Haglund's syndrome (HS) is a painful condition that is caused by an exostosis of the posterior superior part of the calcaneus coupled with Achilles tendinopathy and retrocalcaneal bursitis. Both for the proper musculoskeletal assessment and for the differential diagnosis process of possible concurrent diseases deriving from other anatomical areas, the diagnosis of HS is still a challenge. Case Presentation: A 41-year-old male amateur runner was diagnosed and treated for low back pain and referred leg pain by his general practitioner. Due to ineffective results, he self-presented to a physical therapist (PT) with intense right heel pain, radiating up to the leg and to the lumbopelvic region. Results: The PT's examination and interview relating to the sports activities led to the correct diagnosis and a proper orthopedic referral. At the one-year follow-up, the patient reported regular pain-free marathon running. Discussion: This case report highlights the central role of PTs working in direct access environments as primary care healthcare professionals for the management of musculoskeletal diseases, and their abilities in identifying patients with suspected pathologic conditions that may need referral for imaging, medical assessment or surgical intervention.
