Haglund's Syndrome: A Commonly Seen Mysterious Condition

Abstract

Haglund's deformity was first described by Patrick Haglund in 1927. It is also known as retrocalcaneal exostosis, Mulholland deformity, and 'pump bump.' It is a very common clinical condition, but still poorly understood. Haglund's deformity is an abnormality of the bone and soft tissues in the foot. An enlargement of the bony section of the heel (where the Achilles tendon is inserted) triggers this condition. The soft tissue near the back of the heel can become irritated when the large, bony lump rubs against rigid shoes. The aetiology is not well known, but some probable causes like a tight Achilles tendon, a high arch of the foot, and heredity have been suggested as causes. Middle age is the most common age of affection, females are more affected than males, and the occurence is often bilateral. A clinical feature of this condition is pain in the back of the heel, which is more after rest. Clinical evaluation and lateral radiographs of the ankle are mostly enough to make a diagnosis of Haglund's syndrome. Haglund's syndrome is often treated conservatively by altering the heel height in shoe wear, orthosis, physiotherapy, and anti-inflammatory drugs. Surgical excision of the bony exostoses of the calcaneum is only required in resistant cases.

Keywords: haglund's syndrome; retrocalaneal exostosis.

Figure 1. Clinical photograph of both ankles showing prominent swelling over the back of both heels

Figure 2. Lateral radiograph of ankles showing bony enlargement at the posterosuperior aspect of both calcaneum

Figure 3. MRI image of ankle and foot showing posterosuperior bony spurring of calcaneus, retrocalcaneal bursitis, and impingement of Achilles tendon

Figure 4. Intraoperative image of the bony lesion in Haglund’s syndrome

Figure 5. Excised bony (Haglund’s) lesion