Epidemiology of posterior heel pain

NewsBot · Jan 22, 2015

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Epidemiology of posterior heel pain in the general population: cross-sectional findings from the Clinical Assessment Study of the Foot.
Chatterton BD, Muller S, Roddy E.
Arthritis Care Res (Hoboken). 2015 Jan 20.

Objectives To identify the population prevalence of posterior heel pain (PostHP), related disability, and associated factors.

Methods 9334 adults ≥50 years were mailed a questionnaire. Participants reporting foot pain in the last month shaded foot pain location on a manikin. The Manchester Foot Pain and Disability Index assessed disabling foot pain. Population prevalences of any, bilateral, and disabling PostHP were estimated using weighted logistic regression accounting for non-response. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated between PostHP and age, sex, neighbourhood deprivation, occupational class (professional/intermediate/manual), body mass index (BMI), physical activity, heel height, and diabetes.

Results 5109 questionnaires were received (response 56%). 675 respondents (13%) reported PostHP, of whom 382 had bilateral symptoms. 398 (8%) reported disabling PostHP. PostHP in either foot associated with increasing BMI (25.0-29.9 OR 1.58; 30.0-34.9 2.13; ≥35.0 4.09) and manual occupations (1.96; 95% CI 1.47, 2.62). Bilateral PostHP associated with increasing BMI (25.0-29.9 1.79; 30.0-34.9 2.43; ≥35.0 5.79), diabetes (1.48; 1.07, 2.05), and manual occupations (2.21; 1.48, 3.30). Disabling PostHP associated with increasing BMI (25.0-29.9 1.44; 30.0-34.9 2.50; ≥35.0 4.69), age (aged ≥75 1.41; 1.01, 1.96), manual occupations (1.97; 1.35, 2.88), and diabetes (1.56; 1.04, 1.95). High physical activity was negatively associated with PostHP in either heel (0.43; 0.33, 0.56), bilateral PostHP (0.35; 0.25, 0.49), and disabling PostHP (0.33; 0.23, 0.46).

Conclusion PostHP is prevalent and associated with obesity, manual occupations and physical inactivity. Prospective studies should assess the roles of obesity in causation and weight loss in treatment.
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Admin2 · Jan 22, 2015

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Haglund deformity

NewsBot · Feb 20, 2016

Ultrasound-guided retro-calcaneal bursa corticosteroid injection for refractory Achilles tendinitis in patients with seronegative spondyloarthropathy: efficacy and follow-up study.
Srivastava P, Aggarwal A
Rheumatol Int. 2016 Feb 19

Ultrasound (US)-guided corticosteroid injection has been shown to be safe and effective for varied causes of plantar fasciitis; however, its use for Achilles tendinitis is controversial. We studied the efficacy and changes in US findings at Achilles enthesitis after corticosteroid injection in patients with spondyloarthropathy (SpA). Patients with SpA with symptomatic Achilles enthesitis, refractory to 6 weeks of full-dose NSAIDs, were offered US-guided local corticosteroid injection. Injected entheses were examined by US (both B mode and power Doppler) at baseline and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis. Achilles tendon thickness >5.29 mm, 2 cm proximal to insertion in long axis, was considered thickened. Twenty-seven symptomatic Achilles tendons (in 18 patients) were injected with 20 mg methylprednisolone under US guidance baseline, and 6-week follow-up US features were compared. All patients reported improvement in pain (VAS) in the affected tendon after injection (p < 0.0001). Simultaneously, improvement in local inflammatory changes were noted, in the form of significant reduction in tendon thickness (p < 0.0001), vascularity (p < 0.0001), peritendinous oedema (p = 0.001), bursitis and bursal vascularity (p < 0.001 and < 0.0001, respectively). There was no change in bone erosions and enthesophyte. None of the patients had tendon rupture or other injection-related complications at 6 weeks of follow-up. US-guided local corticosteroid injection is an effective and safe modality for refractory Achilles enthesitis in patients with SpA and leads to reversion of acute changes at entheseal site.
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NewsBot · Feb 14, 2023

Defining Haglund’s Deformity Radiographically by Incorporating the Biomechanics of Ankle Motion
Tonya Conley, James D Michelson
Foot and Ankle Surgery; 14 February 2023

Background
Haglund’s deformity is clinically defined by the presence of retrocalcaneal tenderness, with previous radiographic parameters relying on calcaneal anatomic parameters that did not considering the influence of ankle motion on posterior calcaneal-Achilles impingement

Methods
Standing foot radiographs from 55 patients with clinically defined Haglund’s deformity were compared to 50 control patients using previously described measurements and 2 new angular measurements based on the linkage between ankle rotation and posterior calcaneal-Achilles impingement. The ability of each measure to distinguish between Haglund’s and control patients was assessed.

Results
The combination of the angles to account for both increased calcaneal tubercle height and increased posterior calcaneal prominence could distinguish between the two patient groups (p=.018, Area under the curve = 63.2%). None of the previously published radiographic criteria were different between the two patient groups.

Conclusions
The proposed radiographic criteria were more predictive than previous criteria that did not address the role of ankle motion.
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NewsBot · Feb 27, 2023

Haglund's syndrome: Radiographical evaluation and its clinical relevance.
Sanga A, Kushwaha RK, Vidrohi RK, Sanga P, Dey SK.
Natl J Clin Anat 2023;12:46-9

Background: Haglund's syndrome an important cause of posterior heel pain presents with a prominent bony contour, a retrocalcaneal bursitis or achillis tendinitis these can also occur in isolation hence for the diagnosis of etiology of Haglund's disease certain radiological parameters and soft tissue parameters have been created to evaluate the anatomical variations which will assist in its exact diagnosis. Study aims to distinguish between the bony and soft tissue causes of Haglund's disease radiologically. Methodology: After Institutional ethical committee clearance an observational cross-sectional study was conducted with subjects coming to radiology OPD for X-ray foot with complains of posterior heel pain fulfilling inclusion and exclusion criteria were examined for X-ray lateral view of foot. Parameters like calcaneal inclination angle (CIA), Fowler Philip angle (FPA), parallel pitch line (PPL), Steffenson & Evenson angle (SEA) measured, posterior/calcaneal spur and posterior calcaneal step were noted. The data obtained was analyzed for mean, Standard deviation, sensitivity % and false negative %. Result: Sensitivity of the parameters were analyzed to find CIA, SEA &PPL to be 63.3%, 55% and 55% sensitive respectively. CIA could be assigned most sensitive but regarding soft tissue parameters none were sensitive. Conclusion: CIA, SEA & PPL were found to be sensitive among bony parameters. But none of the soft tissue parameters were sensitive radiologically highlighting a need for its correlation with clinical symptom in peripheral health centers where MRI is not available. Sensitivity of bony and soft tissue parameters were analyzed to find CIA, SEA & PPL to be sensitive. CIA could be assigned most sensitive among bony parameter but with regards to soft tissue parameters none were sensitive.
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NewsBot · Apr 14, 2023

12 Cases of Haglund's Syndrome Detected through MRI
Shuwei Zhou et al
Curr Med Imaging 2023 Mar 9.

Background: Haglund's syndrome is a common cause of heel pain but often neglected clinically. Haglund's syndrome refers to a series of symptoms caused by impingement among posterosuperior prominence of the calcaneus, bursa and Achilles tendon. It is difficult to distinguish Haglund's syndrome from other causes of heel pain by clinical diagnosis. Imageology is of great value in the diagnosis of Haglund's syndrome.

Objective: Our study aims to summarize the Magnet resonance (MR) imaging characteristics of Haglund's syndrome and provide some reference to clinical work.

Method: We retrospectively analyzed the MR images of 11 patients (6 males; 5 females; 6 right ankles, 4 left ankles, 1 bimalleolar ankles) who have been clinically and radiologically confirmed Haglund's syndrome. Observation contents: morphological changes of calcaneus and talus, abnormal signal of calcaneus, abnormal Achilles tendon, and soft tissue abnormalities around Achilles tendon. Combined with literature reviews, summarize the MR imaging features of Haglund's syndrome.

Results: In 12 ankles, all ankles showed posterosuperior prominence of the calcaneus and Achilles tendon degeneration; 7 ankles showed bone marrow edema; 6 Achilles tendons were graded as either type II or type III tendinosis; 5 Achilles tendons showed partial tear; 12 ankles showed retrocalcaneal bursitis, 7 ankles showed retro-Achilles bursitis, 6 ankles showed Kager's fat pad edema.

Conclusion: This study found that MR images of Haglund's syndrome showed bone edema of the calcaneus, degeneration and partial tear of the Achilles tendon, the retrocalcaneal and retro-Achilles bursas, and Kager's fat pad edema.
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