What are the diagnostic requirements for Haglund's deformity (Haglund's syndrome)?

From the Guidelines

The diagnosis of Haglund's deformity requires a combination of clinical evaluation and imaging studies, with a focus on tenderness lateral to the Achilles tendon and a posterior lateral prominence visible on radiographs. When evaluating a patient for Haglund's deformity, it is essential to consider the clinical presentation, which typically includes acute pain and inflammation aggravated by pressure from shoes, as well as pain relief when walking barefoot 1. Key features of the condition include:

• Tenderness present lateral to the Achilles tendon
• A posterior lateral prominence, commonly seen on radiographs
• Symptoms most common in women 20 to 30 years of age, although it can occur in both sexes and at any age Imaging studies, such as lateral X-rays of the foot, are crucial for confirmation of the diagnosis, as they can reveal a prominent posterosuperior calcaneal prominence and associated soft tissue swelling. It is also important to consider differential diagnosis to rule out other causes of posterior heel pain, such as isolated Achilles tendinopathy, plantar fasciitis, or stress fractures of the calcaneus. In cases where initial treatments do not lead to improvement, referral to a podiatric foot and ankle surgeon may be necessary, and immobilization cast or fixed-ankle walker-type device may be used 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:

• Posterosuperior prominence of the calcaneus 5
• Achilles tendon degeneration 5
• Bone marrow edema 5
• Retrocalcaneal bursitis 5
• Retro-Achilles bursitis 5
• Kager's fat pad edema 5
• Non-insertional tendinopathy 6
• Calcaneal oedema 6