Haglund Syndrome

Haglund syndrome is characterized radiographically on the lateral view by the following:

• Prominent calcaneal bursal projection: See below
• Retrocalcaneal bursitis: On the lateral radiograph of the heel, the normal retrocalcaneal recess (rr) extends at least 2 mm below the bursal projection and has a sharp interface along the anterior edge of the Achilles tendon. When this interface is not seen, retrocalcaneal bursitis is suggested.
• Thickening of the Achilles tendon: Anteroposterior diameter larger than 9 mm, 2 cm above the bursal projection and loss of the sharp tendinous interface.
• Convexity of the superficial soft tissues at the level of the Achilles insertion ("pump-bump").

Different methods have been proposed for the detection of the prominent bursal projection. The posterior calcaneal angle of Fowler is formed by the intersection of a line tangent to the anterior tubercle (a) and the medial tuberosity (m) of the calcaneus with the line tangent to the posterior surface of the bursal projection (bp) and the posterior tuberosity (p). An angle larger than 75 degrees is considered positive.

Another method involve construction of parallel pitch lines. As described above, a line is drawn tangent to the anterior tubercle (a) and the medial tuberosity (m) of the calcaneus. A line parallel to this one is drawn from the posterior articular facet of the talus (t). A bursal projection above this line is considered abnormal.

More recent work, however, has found no statistically significant difference in these measures between patients with symptomatic Haglund syndrome and normal controls. The presence of retrocalcaneal exostoses and Achilles tendon calcifications, on the other hand, were statistically significantly different between these two groups.

References

• Lu CC, Cheng YM, Fu YC, Tien YC, Chen SK, Huang PJ. Angle analysis of Haglund syndrome and its relationship with osseous variations and Achilles tendon calcification. Foot Ankle Int. 2007 Feb;28(2):181-5.
• Pavlov H, Heneghan MA, Hersh A, Goldman AB, Vigorita V. The Haglund syndrome: initial and differential diagnosis. Radiology. 1982 Jul;144(1):83-8.