Age / Sex : 76 / F

Chief complaint : palpable mass at the heel, no underlying disease.
What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Seon-Jeong Kim, Myongji Hospital

Discussion

Answer:  

Haglund syndrome

Findings:

Haglund deformity (prominence of the posterosuperior angle of the calcaneus) with calcaneal bone marrow edema and cyst.

Insertional Achilles tendinopathy

Retrocalcaneal bursitis

Inflammatory change in the retro-Achilles fat

Differential Diagnosis:

Achilles insertional tendinopathy, Rheumatoid arthritis or seronegative spondyloarthropathy

Discussion:

• Haglund syndrome (Haglun triad)


• Haglund deformity (prominence of the posterosuperior angle of the calcaneus)


• Insertional Achilles tendinopathy


• Retrocalcaneal bursitis


• Ventral tears of the Achilles tendon and insertional enthesophytes may also be seen


• This condition was attributed to poorly fitting or tight low-back shoes


• Focal pain at posterior heel, palpable soft tissue mass and osseous prominence (“pump bump”), pain with plantar flexion of foot


• Treatment: modification of shoes, steroid injection in retrocaneal bursa, surgical excision of Haglund deformity

References:

Lawrence DA, Rolen MF, Morshed KA, Moukaddam H. MRI of heel pain. AJR Am J Roentgenol. 2013;200(4):845-55

Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR. Am J Roentgenol. 2000;175 (3): 613-25.