The patient presented pain in the Achilles tendon insertion area. The symptoms worsened while walking. The pain had started three years before, becoming worse during the past six months.
Clinically there was redness, a focal bump and swelling. There was also pain when pressing the Achilles tendon insertion.
The axial T1-w and fat suppressed PD-w as well as the sagittal fat suppressed PD-w MR images, showed a small effusion into the tibiotalar joint, a hypertrophic posterior process of the talus in keeping with a Stieda process, Achilles tendon tendinopathy with abnormal signal intensity in its anterior aspect of insertion and reactive bone marrow oedema subcortically at the tendon insertion. There was also bony overgrowth in the superoposterior calcaneus with minor retrocalcaneal bursitis and oedematous soft tissue changes anterior and posterior to the Achilles tendon. Irrelevant associated findings included varicose veins in the medial and anterior aspects of the ankle and bony overgrowth in the calcaneal attachment of the plantar aponeurosis, without indications of plantar aponeurositis.
Haglund’s deformity refers to a bony enlargement on the back of the heel. The soft tissues near the Achilles tendon may become irritated when the bony enlargement rubs against shoes. This often leads to painful local bursitis.
Haglund's deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation. To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include a high-arched foot, a tight Achilles tendon and tendency to walk on the outside of the heel. Haglund’s deformity can occur in one or both feet.
Haglund's syndrome is a constellation of soft tissue and bony abnormalities and represents one cause of retrocalcaneal pain resulting from inflammation of the regional soft tissues, Achilles tendinopathy and bone marrow oedema. In young athletes, posterior impingement may also be a cause of pain. MR imaging is crucial since treatment of the above painful entities are different.
The diagnosis of Haglund's syndrome is often made clinically. Plain radiographs may show increased density in the deep and superficial Achilles bursae on a standing lateral radiograph. Ultrasound may show the bursitis and tendinopathy but is unable to demonstrate the osseous structures. However, ultrasonography is useful to guide treatment of the bursitis and the tendinopathy.
In the case presented here, Achilles tendinopathy presumably resulted from the Haglund's deformity.
Haglund's deformity and chronic Achilles tendinopathy.
In the patient’s left foot/right foot (depending on the specific case), sagittal and transverse MRI of the ankle shows a bony prominence at the posterosuperior aspect of the calcaneus, adjacent to the Achilles tendon (at the Achilles tendon insertion). There is localized soft tissue swelling, thickened bursae signals, and varying degrees of peritendinous edema or thickened signals in the Achilles tendon. Some slices reveal mild bone marrow edema in the adjacent area. Overall, these findings are consistent with the local impingement and irritation changes caused by “Haglund’s deformity.”
Based on the patient’s clinical symptoms (posterior heel pain, swelling, localized redness) and imaging findings, this suggests chronic irritation and inflammation in the region, including bursitis (particularly of the sub-Achilles bursa and retrocalcaneal bursa) and tendinopathic changes in the Achilles tendon.
Taking into account the patient’s age, clinical presentation (chronic pain at the Achilles tendon insertion, localized swelling, tenderness, and redness), and MRI findings of a bony protrusion at the posterosuperior calcaneal margin along with Achilles tendon and soft tissue inflammation, the most likely diagnosis is: Haglund’s Deformity (Haglund’s deformity) with Achilles Tendinopathy and Bursitis (i.e., Haglund’s Syndrome).
If it is necessary to confirm the extent of soft tissue and tendon injury, high-resolution ultrasound may be performed. Further laboratory or pathological examinations (e.g., if a specific infection or disease is suspected) can be considered based on clinical requirements.
The rehabilitation process should follow a gradual, step-by-step approach and adhere to FITT-VP (Frequency, Intensity, Time, Type, Volume, Progression) principles to ensure safety and effectiveness.
This report presents a reference-based medical analysis derived from available data and is not a substitute for an in-person assessment or professional medical advice. In the event of any questions or changes in medical condition, please seek prompt medical attention, and follow the guidance of specialist physicians and rehabilitation therapists.
Haglund's deformity and chronic Achilles tendinopathy.
