Radiological angle assessment of Haglund's deformity: validation on Magnetic Resonance Imaging
N Jenko1, S Ariyaratne1, C Azzopardi1
1Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
Insights
The angle of BRINK on MRI effectively distinguishes Haglund
Area of Science:
- Orthopedic imaging
- Radiology
- Foot and ankle anatomy
Background:
- Haglund's deformity causes posterior heel pain.
- Radiological measurements aid in differentiating symptomatic and asymptomatic cases.
- Traditional assessments use plain radiographs.
Purpose of the Study:
- To identify radiological measurements applicable to Magnetic Resonance Imaging (MRI) for Haglund's deformity.
- To evaluate the diagnostic utility of specific angles and distances on MRI.
Main Methods:
- Retrospective analysis of 30 Haglund's deformity MRI studies and 32 controls.
- Measurement of the angle of BRINK, Achilles angle, Calcaneal pitch, Achilles-plantar fascia angle, and soleus calcaneal distance.
- Utilized optimal T2 fat-saturated sagittal MRI slices.
Main Results:
- The angle of BRINK showed statistically significant difference (p < 0.0001) between groups with good discrimination (AUC = 0.7783).
- Angle of BRINK measurement demonstrated high reproducibility (ICC > 0.82).
- Achilles tendon insertion site, calcaneal edema, and non-insertional tendinopathy were more prevalent in the Haglund's group.
Conclusions:
- The angle of BRINK is a reliable MRI measurement for differentiating Haglund's deformity.
- This measurement can potentially enhance patient management and surgical decision-making.
- Further research should correlate the angle of BRINK with long-term patient outcomes.
Purpose:
Haglund's deformity, an abnormality at the postero-superior corner of the calcaneus is a common cause of posterior heel pain. To date numerous measurements of radiological angles related to the calcaneus have been proposed to differentiate between symptomatic and asymptomatic patients with the deformity. Traditionally, these measurements have been assessed on plain radiographs. The aim of this study was to identify measurements which can be applied to Magnetic Resonance Imaging (MRI) studies of the ankle.
Methods:
A retrospective cohort analysis of 30 MRI ankle studies from patients with symptomatic Haglund's deformity and 32 normal studies as controls was undertaken. The angle of BRINK, the Achilles angle, Calcaneal pitch, Achilles-plantar fascia angle and soleus calcaneal distance were measured on optimal T2 fat-saturated sagittal slices.
Results:
There was a statistically significant difference (p < 0.0001) in the angle of BRINK between the Haglund's and control group. The Area-Under-the-Curve (AUC) was 0.7783 in keeping with good discrimination between the two groups. The angle of BRINK measurement is reproducible, with an intra-observer ICC of 0.837 and an inter-observer ICC of 0.824. There was no statistically significant difference between the two groups for the other measurements. In the Haglund's group the Achilles tendon was more likely to attach to the mid 1/3 of the posterior calcaneus as opposed to the superior 1/3 (p = 0.02), calcaneal oedema was more likely to be present (p < 0.001) and non-insertional tendinopathy was more likely to be present (p < 0.001). The presence of a retrocalcaneal bursa is non-specific (p = 0.602).
Conclusion:
The angle of BRINK demonstrates good discrimination between normal and Haglund's cases on MRI studies and may improve patient management by supporting surgical decision-making. Future work should correlate the angle of BRINK to long-term outcomes.
