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Haglund’s Deformity

- 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

- 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;

- 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;

- 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

Operative management of Haglund's deformity in the non athlete: a retrospective study.

Chronic retrocalcaneal bursitis treated by resection of the calcaneus

Prominence of the calcaneus: late results of bone resection.   

The Achilles tendon insertion is crescent-shaped: an in vitro anatomic investigation.

Surgery for retrocalcaneal bursitis: a tendon-splitting versus a lateral approach.