Insertional Problems Haglunds Deformity

Haglund1 described in 1928 a single patient with a painful hindfoot caused by an enlarged postero-superior border of the calcaneus rubbing against low-back shoes. The mainstay of management of Haglund's deformity was removal of the postero-superior corner of the calcaneus. Classically, patients with Haglund's condition report pain and tenderness at the posterolateral aspect of the cal-caneus, where a prominence, the "pump-bump," can be palpated.

Distinction should be made between Haglund's condition and other conditions such as superficial Achilles tendon bursitis.

Haglund's condition must also be differentiated from Haglund's syndrome. The latter involves painful swelling of the inflamed retrocalcaneal bursa, sometimes combined with Achilles tendi-

nopathy. The retrocalcaneal bursa is located posterior and superior of the calcaneus and just ventral of the Achilles tendon. It provides a smooth gliding surface in dorsiflexion and plantar flexion.2-4 Impingement of the retrocalcaneal bursa between the ventral aspect of the Achilles tendon and the posterosuperior process of the calcaneus can be the cause of this retrocalcaneal bursitis.

Haglund's syndrome is a complex of symptoms involving the retrocalcaneal bursa and the supero-dorso-lateral calcaneus.4-9 Haglund's syndrome is rarely seen acutely. There typically is pain when starting to walk after a period of rest. Operative management consists of removal of the bursa, and when there is a bony prominence this is excised as well.

In insertional tendinopathy, there is thickening of the Achilles tendon at its insertion on the cal-caneus. Pain is often located in the midline. On plain radiography, intratendinous calcifications or an area of ossification can be seen at the site of insertion. In patients who also have retrocalcaneal bursitis, this can be seen as a white shadow in the black Kager's triangle.

Operative management consists of excision of the ossicle and adjacent tissue.

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