- 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;