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Haglund's deformity and retrocalcaneal bursitis
1Cappagh Orthopaedic Hospital, Dublin, Ireland.
Insights
Haglund's deformity involves prominent heel bone projections causing pain and swelling, often worsened by footwear. Conservative treatment is recommended first, with surgery reserved for persistent cases.
Area of Science:
- Orthopedic Surgery
- Podiatry
- Radiology
Background:
- Haglund's deformity is characterized by excessive bursal projection on the calcaneus.
- It is associated with retrocalcaneal bursitis, pain, and swelling, often exacerbated by footwear and foot deformities like cavo varus.
- High heels and rigid heel counters commonly aggravate the condition.
Purpose of the Study:
- To describe the radiological features of Haglund's deformity.
- To outline the diagnostic criteria and treatment modalities for Haglund's deformity and associated Haglund's disease.
- To evaluate the efficacy of surgical intervention and post-operative rehabilitation.
Main Methods:
- Radiological assessment using measurements such as superior calcaneal angle, calcaneal inclination, posterior calcaneal angle, and the upper parallel pitch line.
- Review of conservative treatment approaches.
- Evaluation of surgical outcomes, focusing on bone resection, nerve preservation, and tendon integrity.
Main Results:
- Radiological signs include a superior calcaneal angle >75 degrees, combined calcaneal inclination and posterior calcaneal angle >90 degrees, and excessive bone above the upper parallel pitch line.
- Conservative management is the primary treatment strategy.
- Surgical results are satisfactory when adequate bone is removed without damaging nerves or the Achilles tendon.
Conclusions:
- Haglund's deformity and disease require a stepwise treatment approach, prioritizing conservative methods.
- Surgical intervention for Haglund's deformity can yield good results with careful technique and appropriate post-operative rehabilitation.
- Effective rehabilitation is crucial for restoring function after surgery.
Abstract:
An excessive prominence of the bursal projection in the posterosuperior aspect of the calcaneous constitutes Haglund's deformity. Swelling in this area constitutes Haglund's disease and is associated with retrocalcaneal bursitis. Rigid and prominent heel counters with high heels impinge on the soft tissues overlying the prominence and give rise to symptoms of pain and swelling. Cavo varus deformities exacerbate this problem. The bursal projection can be demonstrated radiologically by a superior calcaneal angle of more than 75 degrees, a combination of calcaneal inclination and a posterior calcaneal angle of more than 90 degrees, and excessive bone above the upper parallel pitch line. Conservative treatment should always be implemented, and only those that have not benefited from such therapy should be considered for surgery. The results of surgery are satisfactory, provided adequate bone has been resected and no damage to local peripheral nerves or the Achilles tendon has been sustained. After a period of immobilization, an appropriate rehabilitation program must complement the treatment to ensure the early return of function to the tendons and surrounding joints.