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35 year old asian male with prominent tibial varum. Has developed painful retrocalcaneal bursitis. Pain also experienced to the medial achilles margin - approx 5cms proximal to the insertion. Aggrevated via running. Both static and dynamic evaluation indicate fully compensated rearfoot varus. Custom devices have been prescribed to address the rearfoot compensation. Any suggestions regarding best practice to decrease the size and severity of the Haglunds? Oral and topical anti's have not had significant effect.

 

Try getting your patient to buy a tube of voltaren or feldene gel and a tube of Hirudoid cream/gel. Get them to mix two 10 cent peice size globules together and apply to the site. Get them to then occlude it with glad wrap or something similar.Apply it each night before bed for 4-5 nights. Shoes with no backs can help prevent any extra irritation.

 

Consider adding heel-lifts and Canonbury supply a sports sock with gel TA shield. I would also get an US scan. That area is relatively avascular and prone to tears.

 

I have gotten good non surgical results by referring patients(or as the case may be for you,actually doing it in your office),physical therapy,thrice weekly for a month.This can break up any inflammation present.

 

I would try increasing the rearfoot posting combining that with a us guided dmi injection into the retro calacaneal bursae.

andrew williams
consultant musculoskeletal specialist

 

If friction against the back of the shoes is an issue, I have had good results by incorporating a spacer at the posterior of the orthoses to displace it and the foot roughly .5cm from the heel of the shoe. If there is limited doesiflexion, I also put a heel raise in accordingly.
Best wishes
Freeman Churchill