From the Guidelines
The diagnosis of Haglund's deformity requires a combination of clinical evaluation and imaging studies, with a focus on the presence of a posterior lateral prominence and tenderness lateral to the Achilles tendon, as well as radiographic evidence of the calcaneal prominence. When evaluating a patient for Haglund's deformity, it is essential to consider the clinical presentation, which typically includes pain and inflammation aggravated by pressure from shoes, relieved by walking barefoot, and tenderness lateral to the Achilles tendon, usually in association with a posterior lateral prominence, as noted in the study by the American College of Foot and Ankle Surgeons 1.
Key Diagnostic Features
- Pain and inflammation at the posterior heel
- Tenderness on palpation of the posterolateral aspect of the calcaneus
- Prominent bump on the back of the heel that becomes painful with shoe wear
- Radiographic evidence of an enlarged posterosuperior calcaneal prominence
Imaging Studies
Imaging is crucial for confirmation, with lateral view X-rays being the primary diagnostic tool, although the provided evidence does not specify the exact radiographic measurements or angles, such as the Fowler-Philip angle, that can help quantify the deformity. In clinical practice, the diagnosis of Haglund's deformity is based on the characteristic clinical presentation combined with radiographic evidence of the calcaneal prominence, distinguishing it from other causes of posterior heel pain, and referral to a specialist may be necessary if initial treatments do not improve symptoms, as suggested by the American College of Foot and Ankle Surgeons 1.
From the Research
Diagnosis of Haglund's Syndrome
The diagnosis of Haglund's syndrome is based on a combination of clinical signs and radiological images. The following are the requirements for diagnosis:
- Clinical evaluation, including pain in the back of the heel, which is more pronounced after rest 2
- Lateral radiographs of the ankle to confirm the presence of a posterosuperior calcaneal exostosis, known as Haglund's deformity 2, 3
- Measurement of the parallel pitch lines in a lateral radiograph of the ankle to assess the severity of the deformity 3
- MRI may be useful in cases of atypical heel pain or to confirm the diagnosis, but it does not influence the therapy of patients with Haglund's deformity 4, 5
- Radiological angle assessment, such as the angle of BRINK, may be used to differentiate between symptomatic and asymptomatic patients with Haglund's deformity 6
Imaging Characteristics
The imaging characteristics of Haglund's syndrome include: