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Spot Diagnosis

Discussion in 'Spot Diagnosis' started by neo_star, Dec 28, 2012.

  1. neo_star

    neo_star Moderator

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    ankle-1_zpsf740e438.jpg

    Can you identify the lesion ?

    Hint: Individuals with high arches are usually predisposed to this deformity.
     

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    Last edited: Dec 28, 2012

  2. bb100

    bb100 Bronze Member

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    Haglund deformity
     

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  3. neo_star

    neo_star Moderator

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    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
     

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