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Novel Radiographic Measurements for Operatively Treated Haglund's Deformity
Shih-Chieh Tang1, Kao-Chang Tu1, Wei-Jen Liao1
1Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Insights
New radiographic measurements, bump height and bump-calcaneus ratio, can diagnose symptomatic Haglund's deformity. The bump-calcaneus ratio is a more reliable indicator for this posterior heel pain condition.
Area of Science:
- Orthopedics
- Radiology
- Podiatry
Background:
- Haglund's deformity causes posterior heel pain due to a bony prominence on the calcaneus.
- Current diagnostic methods lack a standard radiographic parameter for symptomatic cases.
Purpose of the Study:
- To introduce and validate novel radiographic measurements for diagnosing symptomatic Haglund's deformity.
- To differentiate between patients with and without symptomatic Haglund's deformity using new parameters.
Main Methods:
- Retrospective analysis of ankle radiographs from 43 Haglund's deformity patients and 41 controls.
- Measurement and comparison of Fowler-Phillip angle (FPA), parallel pitch lines (PPL), Haglund's deformity height, bump height, and bump-calcaneus ratio.
- Validation of reliability and cut-off values using ICC and ROC curve analysis.
Main Results:
- Bump height and bump-calcaneus ratio showed significant differences between groups (p < 0.001).
- Bump-calcaneus ratio demonstrated higher diagnostic accuracy (AUC) than bump height.
- Optimal thresholds: bump height ≥ 4 mm, bump-calcaneus ratio ≥ 7.5%.
Conclusions:
- Bump height and bump-calcaneus ratio are effective, intuitive radiographic parameters for identifying surgically treated Haglund's deformity.
- The bump-calcaneus ratio is a more reliable diagnostic parameter than bump height.
- These novel measurements aid in diagnosing symptomatic Haglund's deformity.
Background:
Haglund's deformity, which is characterized by a bony prominence of the posterosuperior aspect of the calcaneus, causes posterior heel pain. To date, there is no standard radiographic parameter to diagnose symptomatic Haglund's deformity. Herein, we proposed novel radiographic measurements to distinguish between patients with and without symptomatic Haglund's deformity.
Methods:
We retrospectively evaluated ankle radiographs of 43 patients who underwent surgery for symptomatic Haglund's deformity (Haglund group) and 41 healthy individuals (control group) free of heel complaints. Fowler-Phillip angle (FPA), Heneghan-Pavlov parallel pitch lines (PPL), Haglund's deformity height, bump height, and bump-calcaneus ratio were measured and compared between the groups. Furthermore, the reliability and cut-off value of each parameter were validated via ICC and ROC curve analysis, respectively.
Results:
The bump height (p < 0.001) and the bump-calcaneus ratio (p < 0.001) showed significant differences between the control and Haglund groups, unlike FPA, PPL, and Haglund's deformity height. ROC curve analysis revealed that the AUC of bump-calcaneus ratio was larger than that of bump height. The optimal threshold was 4 mm or higher for bump height and 7.5% or higher for bump-calcaneus ratio. The intra- and inter- observer ICCs were, respectively, 0.965 and 0.898 for bump height and 0.930 and 0.889 for bump-calcaneus ratio.
Conclusions:
This study proposes two novel radiographic parameters to identify operatively treated Haglund's deformity, namely bump height and bump-calcaneus ratio. They are easy to measure and intuitive. Both of them are effective diagnostic parameters for Haglund's deformity. Furthermore, bump-calcaneus ratio is more reliable diagnostic parameter than bump height.
