Imaging description

Haglund’s triad consists of insertional Achilles tendinosis, retrocalcaneal bursitis, and Haglund’s deformity. Haglund’s deformity refers to hypertropic bony projection of the bursal projection (Figure 61.1). Haglund’s syndrome is a common cause of posterior heel pain characterized by a painful soft tissue swelling (pump-bump) at the Achilles tendon insertion. Dr. Haglund coined this entity in 1928 based on the symptom (heel pain) and physical findings typically for those who wore stiff low-back shoes while playing golf or hockey. MRI may show distension of the retrocalcaneal and possibly retro Achilles bursa with fluid signals and thickening of the Achilles tendon with or without signal changes (Figure 61.2).

Importance

Lateral radiograph may detect Haglund’s deformity, distension of retrocalcaneal bursa, thickening of Achilles tendon (> 9 mm, 2 cm above the bursal projection), and soft tissue swelling posterior to the Achilles tendon insertion (retro Achilles bursitis). These findings need to be correlated with the symptoms and physical findings for the diagnosis of Haglund’s syndrome. Inflammatory arthropathy such as reactive arthritis may present with similar findings. Parallel pitch lines (PPL) (Figure 61.3) can be used to determine the prominence of the bursal projection (Haglund’s deformity). However, this can be positive in about one third of asymptomatic individuals. MRI clearly visualizes the components of Haglund’s syndrome.