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Posterior heel pain associated with a calcaneal step and Achilles tendon calcification
Insights
Chronic posterior heel pain is linked to a longer calcaneus and a posterior calcaneal step. These factors may cause Achilles tendon degeneration and injury, leading to pain.
Area of Science:
- Orthopedics
- Sports Medicine
- Radiology
Background:
- Investigating nonrheumatologic, nonmetabolic causes of chronic posterior heel pain.
- Focusing on Haglund's disease, retrocalcaneal bursitis, and "pump bumps" diagnoses.
- Reviewing patient data from 1963-1978 at The Hospital for Special Surgery.
Observation:
- Compared 19 symptomatic patients with 104 controls.
- Radiographic evaluation included calcaneal spurs, Achilles tendon calcifications, and posterior calcaneal step.
- Fowler-Philip measurements were analyzed.
Findings:
- Symptomatic heels showed significantly longer horizontal calcaneal length (p < 0.05).
- Higher incidences of Achilles tendon calcification (p = 0.004) and posterior calcaneal step (p < 0.001) in the symptomatic group.
- Fowler-Philip angles were not significantly different between groups (p > 0.05).
Implications:
- Increased horizontal calcaneal length and posterior calcaneal step appear to cause chronic posterior heel pain.
- These factors may lead to degenerative Achilles tendon lesions, microscopic injury, reduced vascularity, and decreased strength.
- A posterior calcaneal step may alter tendon tension, potentially causing calcification or rupture.
Abstract:
Factors are examined which may be associated with chronic posterior heel pain of nonrheumatologic and nonmetabolic etiology. The charts of patients in whom Haglund's disease retrocalcaneal bursitis, or "pump bumps" was diagnosed during the period from 1963-1978 at The Hospital for Special Surgery, were reviewed. Nineteen patients met the criteria of symptomatic patients. The radiographs in 12 of these patients were available for review. These cases and 104 control cases were evaluated for the presence of calcaneal spurs, Achilles tendon calcifications and a posterior calcaneal step. In addition, Fowler-Philip measurements were obtained from the radiographs and compared with Fowler and Philip's results. Although the Fowler-Philip angles of the two groups were not significantly different (p greater than 0.05), the symptomatic heels had a significantly longer horizontal calcaneal length (p less than 0.05). The incidences of Achilles tendon calcification (p = 0.004) and of a posterior calcaneal step (p less than 0.001) were higher in patients who had chronic posterior heel pain as compared to a control population. An increased horizontal length of the calcaneus and the presence of a posterior calcaneal step appeared to cause chronic posterior heel pain and degenerative lesions of the Achilles tendon. Although a posterosuperior calcaneal prominence is theoretically important, it was not in this series. A posterior calcaneal step may alter the tension within the tendon, resulting in microscopic tendon injury, decreased vascularity and loss of strength, with subsequent calcification or rupture.