Can you identify the lesion ? Hint: Individuals with high arches are usually predisposed to this deformity.
Answer: Haglund's Deformity [HR][/HR] - Discussion:- inflammation can be related to a Haglund deformity (postero-superior prominence - normal varient) which causes an overlying bursitis; - prominence of the posterior superior calcaneal tuberosity contributes to inflammation of the overlying tissues and the Achilles tendon; - most often occurs in women and is related to shoe wear w/ rigid heels or heel counters; - patients note posterolateral prominence and tenderness; - diff dx: achilles tendinitis [HR][/HR] - MRI: - useful to determine if there are distinct degenerative areas within the tendon (achilles tendinosis), which might require debridement if resection of the Haglund's deformity were indicated; [HR][/HR] - Non Operativer Treatment: - non operative treatment consists of heel cord stretching, change in shoe wear, NSAIDS; - raising the heel out of the shoe with a heel insert, shifts the contact against the heel and often relieves symptoms; [HR][/HR] - Operative Treatment: - excision of the Haglund prominence can be effective in chronic cases; - excision must be kept proximal to the achilles insertion; - lateral approach is easier but care must be taken to avoid sural nerve; - medial incision may also be used; - vertical incision is made 1 cm anterior and parallel to the medial border of the Achilles tendon, and down onto the calcaneus; - posterior calcaneal tuberosity is removed, and the Achilles tendon is debrided and reattached using bone anchors; - Achilles tendon is dissected subperiosteally at insertion of Achilles tendon (about 50% of the tendon is elevated) and calcaneal prominence is removed; - average size of the excised fragment is 3 cm wide, 3 cm long, and 6 mm thick; - calcium deposits are removed from the Achilles tendon if they are present; - patients are immobilized for four weeks ref - Haglund's Deformity - Wheeless' Textbook of Orthopaedics
