Answer for BIR CoW 15 Dec 2024
Haglund deformity
Findings
X-ray: Evidence of bony protrusion involving the posterosuperior aspect of the calcaneum noted. Plantar calcaneal spur noted. Calcifications involving insertion of the Achilles tendon noted. MRI: T1 sagittal image shows evidence of bony protrusion involving the posterosuperior aspect of the calcaneum noted. Plantar calcaneal spur noted. Calcifications involving insertion of the Achilles tendon noted The PDF sagittal image shows fluid signal in the retrocalcaneal bursa. The Achilles tendon appears bulky with hyperintensity at the insertion site. The PDF axial image shows hyperintensity involving the Achilles tendon.
Discussion
Haglund deformity, also known as a pump bump, Bauer bump, or Mulholland deformity, is defined as bony enlargement formed at the posterosuperior aspect of the calcaneum. This deformity leads to retrocalcaneal bursitis. Pathology Haglund deformity may result from the chronic pressure of rigid shoes. Haglund syndrome refers to the triad (Haglund triad) of: Insertional Achilles Tendinopathy Retrocalcaneal bursitis Haglund deformity (i.e., posterosuperior calcaneal exostosis) Plain radiograph Prominent bursal projection of the calcaneum ("pump bump") or haglund deformity Loss of the kager triangle due to retrocalcaneal bursitis Achilles tendon measuring >9 mm in thickness indicating Achilles tendinopathy Convexity of the soft tissues posterior to the Achilles tendon insertion due to superficial retro-Achilles bursitis Chauveaux-Liet angle >12º Ultrasound Ultrasound findings are similar to MRI and depend on availability and referrer preference. It is typically used for patients with diagnostic uncertainty to better assess soft tissues. Findings include: Focal thickening and hyperemia of the distal Achilles tendon and enthesis Achilles tendinopathy and/or partial thickness tear Retrocalcaneal and/or retro-achilles bursitis MRI MRI is also used for patients with diagnostic uncertainty to better assess soft tissues. Findings include: Achilles tendinosis evidenced by focal enlargement and abnormal signal in the distal Achilles tendon Achilles partial thickness tear and/or Achilles insertional tendinopathy Retrocalcaneal and/or retro-achilles bursitis Calcaneal bony spur best appreciated on the T1 sagittal images. Marrow edema in the posterior calcaneal tuberosity in severe cases Differential diagnosis Achilles tendinopathy Achilles tendon tear Achilles tendon thickening calcaneal stress fracture os trigonum syndrome
Findings
X-ray: Evidence of bony protrusion involving the posterosuperior aspect of the calcaneum noted. Plantar calcaneal spur noted. Calcifications involving insertion of the Achilles tendon noted. MRI: T1 sagittal image shows evidence of bony protrusion involving the posterosuperior aspect of the calcaneum noted. Plantar calcaneal spur noted. Calcifications involving insertion of the Achilles tendon noted The PDF sagittal image shows fluid signal in the retrocalcaneal bursa. The Achilles tendon appears bulky with hyperintensity at the insertion site. The PDF axial image shows hyperintensity involving the Achilles tendon.
Discussion
Haglund deformity, also known as a pump bump, Bauer bump, or Mulholland deformity, is defined as bony enlargement formed at the posterosuperior aspect of the calcaneum. This deformity leads to retrocalcaneal bursitis. Pathology Haglund deformity may result from the chronic pressure of rigid shoes. Haglund syndrome refers to the triad (Haglund triad) of: Insertional Achilles Tendinopathy Retrocalcaneal bursitis Haglund deformity (i.e., posterosuperior calcaneal exostosis) Plain radiograph Prominent bursal projection of the calcaneum ("pump bump") or haglund deformity Loss of the kager triangle due to retrocalcaneal bursitis Achilles tendon measuring >9 mm in thickness indicating Achilles tendinopathy Convexity of the soft tissues posterior to the Achilles tendon insertion due to superficial retro-Achilles bursitis Chauveaux-Liet angle >12º Ultrasound Ultrasound findings are similar to MRI and depend on availability and referrer preference. It is typically used for patients with diagnostic uncertainty to better assess soft tissues. Findings include: Focal thickening and hyperemia of the distal Achilles tendon and enthesis Achilles tendinopathy and/or partial thickness tear Retrocalcaneal and/or retro-achilles bursitis MRI MRI is also used for patients with diagnostic uncertainty to better assess soft tissues. Findings include: Achilles tendinosis evidenced by focal enlargement and abnormal signal in the distal Achilles tendon Achilles partial thickness tear and/or Achilles insertional tendinopathy Retrocalcaneal and/or retro-achilles bursitis Calcaneal bony spur best appreciated on the T1 sagittal images. Marrow edema in the posterior calcaneal tuberosity in severe cases Differential diagnosis Achilles tendinopathy Achilles tendon tear Achilles tendon thickening calcaneal stress fracture os trigonum syndrome
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!