Haglund’s Deformity

Wikis > Orthopaedics > Haglund's Deformity

Painful bony prominence at posterior superior aspect of the calcaneus – usually associated with a bursitis. Prominence may be a normal variant that is irritated by shoes  bursitis – the bursitis may be an inflammation of the bursa deep or superficial to the tendo Achilles (deep bursa is banana or “boomerang” shape, resting on calcaneus.

Clinical features:
Prominence of posterior, superior. lateral aspect of calcaneus
Pain and tenderness – exacerbated by shoes. If deep bursa is involved  may be painful on dorsiflexion.

X-ray:
Fowler-Philip angle is usually >75 degrees
Normally have a 2mm radiolucent area between achilles tendon insertion and calcaneus – if this is lost  inflammation of bursa

Differential diagnosis – insertional achilles tendinosis; achilles tendonitis; rheumatoid arthritis; seronegative arthritis.

Treatment:
Heel lift (to raise prominence above counter of shoe); accommodative padding to relieve pressure; use of shoes with heel counter modified to apply no pressure in area; steroid injections into bursa; aspiration of bursa; control of excessive rearfoot motion if present

Foot orthoses with posteriorly extended heel post to move shoe counter away from foot.

Surgical:
Removal of inflamed bursa and resection of bony prominence
Wedge osteotomy of calcaneus to change pitch/angle of calcaneus

 
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