Management of Retrocalcaneal Pain

NewsBot · Jul 28, 2012

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Nonoperative Management of Retrocalcaneal Pain With AFO and Stretching Regimen.
Johnson MD, Alvarez RG.
Foot Ankle Int. 2012 Jul;33(7):571-81.

BACKGROUND:
Retrocalcaneal heel pain is caused by a spectrum of etiologies all resulting in the same symptom of pain at the tendon-Achilles insertion. Several studies have reported the outcomes of operative treatment, but none have reported the outcomes or success rates of nonoperative treatment. We describe a detailed treatment algorithm and report the clinical outcomes.

METHODS:
One hundred thirty-five patients were prescribed a treatment regimen consisting of an AFO and stretching program and were enrolled in our prospective study. One hundred three patients completed pre- and post-treatment Foot Function Indices and were included in the analysis. The effect on FFI from clinical and radiographic factors was examined.

RESULTS:
Of the study population, 76% had a BMI greater than 25, 80% were older than 50 years, and 75% had an exostosis on radiographs. The mean pre-treatment FFI was 48.4 and the mean post-treatment FFI was 18.6 indicating a statistically significant improvement in function of 29.8. Neither BMI nor age had a significant effect on the magnitude of improvement; though, smokers had significantly less improvement. FFI improvement in patients with an exostosis were less than those without an exostosis. Patients with an exostosis less than 1 cm had less improvement than those with an exostosis of 1 cm or more. Patients with Types I and III exostoses had significantly less improvement in FFI compared to Types II and IV. Twelve of the 103 (11.6%) were not pleased with the results of nonoperative treatment and elected to have a procedure performed.

CONCLUSION:
Our study is the first to report the outcome of non operatively treated retrocalcaneal heel pain and to classify retrocalcaneal exostoses. Using our treatment algorithm, we had an 88% success rate in alleviating symptoms and avoiding surgery. Our data suggests that the use of an AFO and stretching regimen may benefit patients suffering from retrocalcaneal heel pain.
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Admin2 · Jul 28, 2012

Related Threads:
Other threads tagged with Haglund Deformity
Insertional Achilles Tendinitis and Haglund’s Deformity
Surgery for Retrocalcaneal Bursitis: A Tendon-splitting versus a Lateral Approach
Retro-calcaneal bursae
Retrocalcaneal Pain: Diagnostic ultrasound case study
Haglunds in an elite marathon runner
Reduction of retrocalcaneal bursitis?
Posterior Calcaneal Exostosis

NewsBot · Nov 27, 2012

Haglund Syndrome with Pump Bump.
Kucuksen S, Karahan AY, Erol K.
Med Arh. (2012), [cited November 26, 2012]; 66(6): 425-427.

Haglund’s syndrome, which is an inflammation of the bursa and a bony enlargement on the back of the heel that most often leads to painful bursitis, is a rare cause of retrocalcaneal pain. The clinical diagnosis is often confusing as the clinical picture may mimic other causes of hindfoot pain such as isolated retrocalcaneal bursitis or hindfoot involvement from more systemic disorders such as seronegative spondyloarthropathies (Reiter’s syndrome, ankylosing spondylitis) or rheumatoid arthritis. This report is of a 60-year-old woman with a painful swelling of the right heel, who was diagnosed with Haglund syndrome. The characteristic clinical photograph (showing the prominent ‘pump bump’), radiographical and magnetic resonance imaging features are presented.
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NewsBot · May 28, 2013

Tuberculosis of the calcaneum masquerading as Haglund's deformity: a rare case and brief literature review.
Gillott E, Ray P.
BMJ Case Rep. 2013 May 24;2013

An Asian man presented to the Foot and Ankle Clinic with a 5-month history of right ankle pain of gradual onset. He had a non-fluctuant swelling around the Achilles tendon insertion with a tender palpable lump. Radiograph demonstrated Haglund's deformity and also possible calcification at the attachment of the Achilles tendon for which he had an injection of a local anaesthetic and a steroid to treat the insertional Achilles tendinitis. A few months later, he developed acute anorexia, abdominal distension secondary to ascites and groin lymphadenopathy. Histology of the lymph node biopsy revealed granulomatous lymphadenitis consistent with tuberculosis (TB) and started on quadruple agent anti-TB treatment. The sample was not cultured. He developed constant ooze from his groin lymph node biopsy site and also fluctuance around the Achilles tendon and heel. Pus from the heel stained positive for auramine indicating TB calcaneum with subsequent culture for acid fast bacilli (AFB) confirming diagnosis of TB calcaneum.
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NewsBot · Mar 4, 2022

Surface Shape of the Calcaneal Tuberosity and the Occurrence of Retrocalcaneal Bursitis among Runners
Agnieszka Wnuk-Scardaccione et al
Int J Environ Res Public Health. 2021 Mar 11;18(6):2860

Purpose: The aim of the study was to establish the relationship between the shape of the calcaneal tuberosity (flat, stepped, rounded, normal) and the probability that retrocalcaneal bursitis among people who train running regularly.

Methods: The study included a group of 30 runners who suffered from retrocalcaneal bursitis in the past, and 30 people who never had symptoms of this disease. The study was based on a diagnostic survey, as well as on clinical examination. The surface of the calcaneal tuberosity and the slope of the calcaneus were assessed using X-rays. The mobility of the bursa, its surface size, the thickness of the Achilles tendon and its attachment rate were established during an ultrasound examination.

Results: Flat surface of the calcaneal tuberosity increases fourfold the risk of suffering from retrocalcaneal bursitis (OR = 4.3). The people whose calcaneus slope is above 25° are at increased risk of suffering from such an inflammation compared with the people whose calcaneus bone is more horizontal (OR = 2.8). The analysis shows that the thickness of the Achilles tendon (p = 0.001), the surface size of the bursa (p = 0.009), as well as the flat surface of the calcaneal tuberosity (p = 0.008) are strongly associated with the occurrence of retrocalcaneal bursitis.

Conclusions: The flat shape of the calcaneal tuberosity increases the risk of bursitis. The risk of inflammation is higher when the Achilles tendon is thicker and the surface of the bursa is smaller than normal.
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NewsBot · Mar 3, 2024

Heel Pain Management in Haglund's Deformity Targeting Sural Nerve Branches under Ultrasound Guidance: Case Report
Sasmit Dipak Lotliker et al
J Orthop Case Rep. 2024 Feb;14(2):12-17

Introduction: Haglund's deformity is an abnormality of the bone and soft tissue of the foot, also known as retrocalcaneal exostosis, Mulholland deformity, and "pump bump". The etiology is not well known. Probable causes include a tight Achilles tendon, a high arch of the foot, and hereditary. The clinical features consist of pain at the posterior aspect of the heel which is predominantly present when the patient begins to walk after a period of rest or inactivity.

Case report: We report a case of a 60-year-old teacher with left heel pain for 3 years, unable to stand or walk for more than 15 min due to pain. We diagnosed him as a case of Haglund's deformity and treated him with ultrasound-guided injections targeting the superficial branches of the sural nerve. This case report illustrates a rarely described modality for the management of heel pain due to Haglund's deformity. Targeting superficial branches of the Sural nerve under ultrasound guidance can act as a superior treatment modality for the management of heel pain due to Haglund's deformity.

Conclusion: Haglund's deformity is a cause of pain in the hindfoot that should be taken into account in the differential diagnosis of any patient presenting with heel pain. Ultrasonography has proved to be an important cost-effective tool in the diagnosis and management of various ankle pathologies like Haglund's deformity, thereby reducing the sole dependence on surgical management. Targeting the superficial (cutaneous) branches of the sural nerve can give satisfactory long-term relief of heel pain in patients with Haglund deformity.
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