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Heel Pain Management in Haglund's Deformity Targeting Sural Nerve Branches under Ultrasound Guidance: Case Report
Sasmit Dipak Lotliker1, Sidharth Verma2, Akhil Bhalla3
1Department of Pain Medicine, Manipal Hospital , Goa, India.
Insights
Haglund's deformity causes heel pain. Ultrasound-guided injections targeting the sural nerve offer a novel and effective treatment, providing long-term relief for this condition.
Area of Science:
- Orthopedics
- Podiatry
- Pain Management
Background:
- Haglund's deformity, also known as retrocalcaneal exostosis, causes posterior heel pain.
- Etiology is multifactorial, potentially involving tight Achilles tendons, high arches, and genetics.
- Pain is often exacerbated by rest or initial activity.
Introduction:
Haglund's deformity is an abnormality of the bone and soft tissue of the foot, also known as retrocalcaneal exostosis, Mulholland deformity, and "pump bump". The etiology is not well known. Probable causes include a tight Achilles tendon, a high arch of the foot, and hereditary. The clinical features consist of pain at the posterior aspect of the heel which is predominantly present when the patient begins to walk after a period of rest or inactivity.
Case Report:
We report a case of a 60-year-old teacher with left heel pain for 3 years, unable to stand or walk for more than 15 min due to pain. We diagnosed him as a case of Haglund's deformity and treated him with ultrasound-guided injections targeting the superficial branches of the sural nerve. This case report illustrates a rarely described modality for the management of heel pain due to Haglund's deformity. Targeting superficial branches of the Sural nerve under ultrasound guidance can act as a superior treatment modality for the management of heel pain due to Haglund's deformity.
Conclusion:
Haglund's deformity is a cause of pain in the hindfoot that should be taken into account in the differential diagnosis of any patient presenting with heel pain. Ultrasonography has proved to be an important cost-effective tool in the diagnosis and management of various ankle pathologies like Haglund's deformity, thereby reducing the sole dependence on surgical management. Targeting the superficial (cutaneous) branches of the sural nerve can give satisfactory long-term relief of heel pain in patients with Haglund deformity.
