Clinics in diagnostic imaging (170)

A 30-year-old woman presented with a six-month history of left posterior heel pain. Physical examination revealed a tender, inflamed and indurated posterior heel with a visible bony prominence of the posterosuperior aspect of the calcaneus. Lateral ankle radiography showed a prominent left posterosuperior calcaneal tuberosity and thickening of the distal Achilles tendon outline. Magnetic resonance imaging demonstrated high-signal inflammatory fluid in the retrocalcaneal bursa, increased signal intensity and thickening of the Achilles tendon, and prominence of the posterior calcaneus tuberosity with reactive marrow oedema. The findings are consistent with Haglund's deformity. The patient underwent hind foot surgery after failing a six-month course of conservative therapy. There was no further recurrence of symptoms after surgery. The clinical and radiological features of Haglund's deformity are described, including a short discussion of other causes of hind foot pain.

Surgical Management of Insertional Achilles Tendinopathy with Haglund's Deformity: A Preliminary Report / 대한정형외과학회잡지

PURPOSE: We wanted to report on treatment outcomes in insertional Achilles tendinopathy patients with Haglund's deformity that were operated on using a central achilles tendon splitting approach. MATERIALS AND METHODS: We enrolled six cases of insertional tendinopathy with concomitant Haglund's disease who underwent an operation between January, 2007 and November, 2008 and for whom follow-up duration for more than 1 year were available. The mean age was 41.5 (21-62) years; the mean follow-up period was 16.3 (12-24) months. Resection of retrocalcaneal bony prominences and inflamed bursa with debridement of degenerative tendons was done using central splitting approach in all cases. A lateral ankle radiograph was used to assess the amount of bony resection. Clinical and functional evaluations were done before and after the operation. RESULTS: In all cases, retrocalcaneal bony prominences were completely resected. Clinical and functional outcomes were significantly improved. One case had a mild tingling distal to the operative lesion. There were no other complications. CONCLUSION: A central splitting approach is an efficient procedure that can provide sufficient exposure to remove pathologic lesions in patients with insertional Achilles tendinopathy accompanying Haglund's disease.

Clinical Utility of Radiographic Measurements of Insertional Achilles Tendinitis with Haglund's Deformity / 대한족부족관절학회지

PURPOSE: It is to analyze the clinical utility of radiograhpic measurements for the insertional Achilles tendinitis patients who have Haglund's deformity and to evaluate the radiographic values related to Haglund's deformity in normal Korean population. MATERIALS AND METHODS: We used the angle of Fowler and Philip, parallel pitch lines (PPL) and Chauveaux-Liet (CL) angle as radiographic measurements. We examined 50 cases of insertional Achilles tendinits patients and another 50 cases of normal foot as a control. RESULTS: In normal feet, the mean value of angle of Fowler and Philip was 53.22 degrees, CL angle was -33.14 degrees and the PPL showed positive in 48%. In case of insertional Achilles tendinitis, the mean values were 55.39 degrees, -33.63 degrees, positive in 56% respectively. There were not statistically significant differences (p>0.05). CONCLUSION: The radiographic values for Haglund's deformity between insertional Achilles tendinitis feet and the normal feet did not show significant difference. Therefore, it seems that the clinical utility of radiographic measurements for the insertional Achilles tendinitis with Haglund's deformity is not useful and the development of new diagnostic methods as MRI and ultrasonography is required.

Clinical Utility of Radiographic Measurements of Insertional Achilles Tendinitis with Haglund's Deformity / 대한족부족관절학회지

PURPOSE: It is to analyze the clinical utility of radiograhpic measurements for the insertional Achilles tendinitis patients who have Haglund's deformity and to evaluate the radiographic values related to Haglund's deformity in normal Korean population. MATERIALS AND METHODS: We used the angle of Fowler and Philip, parallel pitch lines (PPL) and Chauveaux-Liet (CL) angle as radiographic measurements. We examined 50 cases of insertional Achilles tendinits patients and another 50 cases of normal foot as a control. RESULTS: In normal feet, the mean value of angle of Fowler and Philip was 53.22 degrees, CL angle was -33.14 degrees and the PPL showed positive in 48%. In case of insertional Achilles tendinitis, the mean values were 55.39 degrees, -33.63 degrees, positive in 56% respectively. There were not statistically significant differences (p>0.05). CONCLUSION: The radiographic values for Haglund's deformity between insertional Achilles tendinitis feet and the normal feet did not show significant difference. Therefore, it seems that the clinical utility of radiographic measurements for the insertional Achilles tendinitis with Haglund's deformity is not useful and the development of new diagnostic methods as MRI and ultrasonography is required.