Case Report
Haglund's Syndrome. Two Case Reports
Síndrome de Haglund. A propósito de 2 casos
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Two Case Reports" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "37" "paginaFinal" => "38" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Florencio Jiménez Martín, María Dolores Alonso Valdazo, Gara Díaz Peña, Julia Fernández Leroy, David Hernández Herrero, Fermín Díaz García" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Florencio" "apellidos" => "Jiménez Martín" "email" => array:1 [ 0 => "fljmartin@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Dolores" "apellidos" => "Alonso Valdazo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Gara" "apellidos" => "Díaz Peña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Julia" "apellidos" => "Fernández Leroy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "David" "apellidos" => "Hernández Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Fermín" "apellidos" => "Díaz García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Rehabilitación, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Traumatología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Haglund. A propósito de 2 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 925 "Ancho" => 995 "Tamanyo" => 96998 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lateral radiograph of ankle. The arrow signals the posterosuperior exostosis of the calcaneus, which exceeds the upper line in the parallel pitch line method and, thus, the cause is considered to be Haglund's deformity.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Haglund's syndrome was described for the first time in 1928 by Patrick Haglund. It is a cause of tendino-bursitis entrapment of the heel, produced by a posterosuperior exostosis of the calcaneus (Haglund's deformity), accompanied by Achilles tendinitis and retrocalcaneal bursitis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although its pathogenesis is unknown, there have been reports proposing predisposing mechanical factors such as shoes that are too tight, high heels worn by women, an increased plantar arch, Achilles tendon too tense and situations that increase friction between the tendon and the bone.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The differential diagnosis should include xanthomatosis, seronegative spondyloarthropathies and gouty and rheumatoid arthritis.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 37-year-old woman with a 10-month history of pain located in the Achilles region of right foot, which became more intense with activity. The physical examination revealed the thickening of the Achilles tendon with pain on palpation, the stability of ankle and foot joints was conserved, and the Thompson test was negative. A lateral radiograph of the ankle revealed swelling of the soft tissue of the distal third of the Achilles tendon and a posterosuperior prominence of the calcaneus. Ultrasound showed a hypoechoic Achilles tendon, calcification at its insertion into the calcaneus and hypoechoic images of the Kager fat pad. The symptoms disappeared after physical therapy.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 2</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was a 62-year-old woman who had been treated surgically for Haglund's syndrome with retrocalcaneal bursitis and osteotomy of Haglund's deformity. Five months after the intervention, she came to our clinic with little improvement in the symptoms. She presented with inflammation and pain in the distal third of the Achilles tendon, difficulty in dorsiflexion of the ankle and claudication. The symptoms partially remitted after physiotherapy.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Haglund's syndrome is a cause for mechanical pain in the hindfoot. There are several theories about its pathogenesis, although some authors point out the continuous contraction of the sural triceps, which produces an entrapment of the Achilles tendon and the retrocalcaneal bursa against the posterosuperior calcaneal exostosis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Other authors propose that the process begins with an external compression on the heel, which applies pressure to the retrocalcaneal bursa, which then presses on the outer part of the calcaneus. Thus, the calcaneal tuberosity increases in size in response to this chronic irritation, and the tuberosity, in turn, compresses the bursa and the Achilles tendon, provoking a vicious circle.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis is reached on the basis of the clinical signs and radiological images using the measurement of the parallel pitch lines (PPL) in a lateral radiograph of the ankle. This method consists in tracing a line tangent to the lower margin of the calcaneus, and another parallel to the first on the upper margin, at the height of the highest point of the posterior margin of the subtalar joint surface. If the tuberosity exceeds this line, the cause is considered to be Haglund's deformity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,5</span></a> In some cases, the diagnosis can be completed using ultrasound or magnetic resonance imaging.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The initial treatment should be conservative, with the avoidance of shoes that are too tight or have a high heel, using foot orthoses, oral anti-inflammatory drugs, local corticosteroid injection and physiotherapy.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,7</span></a> If there is no response to conservative treatment, surgery would be indicated. The technique most frequently used is retrocalcaneal bursectomy with osteotomy of Haglund's deformity, as the central approach to the tendon has been found to be safe and effective.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–10</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Haglund's syndrome is a cause of pain in the hindfoot that should be taken into account in the differential diagnosis. It should be suspected in the light of the clinical characteristic finding, and be confirmed by radiological studies to ensure a correct diagnosis. Conservative treatment involving medical and physical therapy should be the first option before surgery.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical Disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of human and animal subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres798097" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec796071" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres798098" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec796072" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Clinical Observation" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 2" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 8 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-11-10" "fechaAceptado" => "2015-12-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec796071" "palabras" => array:3 [ 0 => "Haglund's syndrome" 1 => "Achilles tendon" 2 => "Calcaneus" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec796072" "palabras" => array:3 [ 0 => "Síndrome de Haglund" 1 => "Tendón de Aquiles" 2 => "Calcáneo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Haglund's syndrome produces posterior impingement of the heel, which is caused by a posterosuperior calcaneal exostosis, known as Haglund's deformity, associated with Achilles tendinitis and retrocalcaneal bursitis. Its pathogenesis is unknown. We report two cases that were diagnosed clinically and confirmed radiographically. One patient was treated conservatively and the other underwent surgery. The diagnosis is based on clinical signs and radiological images, using the measurement of the parallel pitch lines, in a lateral radiograph of the ankle. Initial treatment is usually conservative and includes anti-inflammatory or analgesic agents, physiotherapy and low-heeled, open-heeled shoes. If conservative treatment does not relieve the pain, surgery may be necessary.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El síndrome de Haglund es una causa de atrapamiento tendino-bursal posterior del talón, producida por una exostosis posterosuperior del calcáneo, denominada deformidad de Haglund, asociada a tendinitis aquílea y bursitis retrocalcánea. Su patogenia es desconocida. Se presentan 2 casos, diagnosticados clínicamente, confirmados radiológicamente, y tratados conservadoramente uno y con cirugía el otro. El diagnóstico se realiza por la clínica y por las imágenes radiológicas con el método de medición de las líneas de inclinación paralelas, en una radiografía lateral del tobillo. El tratamiento inicial suele ser conservador e incluye antiinflamatorios o analgésicos, fisioterapia y zapatos con talón abierto y sin tacón alto. Si el tratamiento conservador no alivia el dolor, puede ser necesaria la cirugía.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez Martín F, Alonso Valdazo MD, Díaz Peña G, Fernández Leroy J, Hernández Herrero D, Díaz García F. Síndrome de Haglund. A propósito de 2 casos. Reumatol Clin. 2017;13:37–38.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 925 "Ancho" => 995 "Tamanyo" => 96998 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lateral radiograph of ankle. The arrow signals the posterosuperior exostosis of the calcaneus, which exceeds the upper line in the parallel pitch line method and, thus, the cause is considered to be Haglund's deformity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Terminology for Achilles tendon related disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.N. Van Dijk" 1 => "M.N. van Sterkenburg" 2 => "J.I. Wiegerinck" 3 => "J. Karlsson" 4 => "N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 12 | 30 |
| 2024 October | 95 | 52 | 147 |
| 2024 September | 126 | 36 | 162 |
| 2024 August | 125 | 56 | 181 |
| 2024 July | 124 | 50 | 174 |
| 2024 June | 77 | 60 | 137 |
| 2024 May | 109 | 53 | 162 |
| 2024 April | 94 | 51 | 145 |
| 2024 March | 102 | 47 | 149 |
| 2024 February | 118 | 43 | 161 |
| 2024 January | 102 | 21 | 123 |
| 2023 December | 86 | 24 | 110 |
| 2023 November | 104 | 55 | 159 |
| 2023 October | 125 | 51 | 176 |
| 2023 September | 101 | 48 | 149 |
| 2023 August | 74 | 19 | 93 |
| 2023 July | 77 | 25 | 102 |
| 2023 June | 93 | 38 | 131 |
| 2023 May | 82 | 33 | 115 |
| 2023 April | 80 | 17 | 97 |
| 2023 March | 108 | 54 | 162 |
| 2023 February | 87 | 31 | 118 |
| 2023 January | 75 | 32 | 107 |
| 2022 December | 63 | 50 | 113 |
| 2022 November | 96 | 35 | 131 |
| 2022 October | 110 | 29 | 139 |
| 2022 September | 100 | 55 | 155 |
| 2022 August | 97 | 60 | 157 |
| 2022 July | 89 | 53 | 142 |
| 2022 June | 110 | 42 | 152 |
| 2022 May | 84 | 56 | 140 |
| 2022 April | 96 | 57 | 153 |
| 2022 March | 114 | 52 | 166 |
| 2022 February | 124 | 28 | 152 |
| 2022 January | 183 | 53 | 236 |
| 2021 December | 127 | 44 | 171 |
| 2021 November | 153 | 45 | 198 |
| 2021 October | 161 | 79 | 240 |
| 2021 September | 186 | 43 | 229 |
| 2021 August | 139 | 53 | 192 |
| 2021 July | 150 | 31 | 181 |
| 2021 June | 229 | 31 | 260 |
| 2021 May | 180 | 72 | 252 |
| 2021 April | 453 | 92 | 545 |
| 2021 March | 307 | 49 | 356 |
| 2021 February | 161 | 18 | 179 |
| 2021 January | 169 | 16 | 185 |
| 2020 December | 177 | 33 | 210 |
| 2020 November | 180 | 18 | 198 |
| 2020 October | 134 | 16 | 150 |
| 2020 September | 124 | 38 | 162 |
| 2020 August | 111 | 16 | 127 |
| 2020 July | 88 | 28 | 116 |
| 2020 June | 79 | 42 | 121 |
| 2020 May | 55 | 26 | 81 |
| 2020 April | 51 | 22 | 73 |
| 2020 March | 12 | 4 | 16 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 52 | 5 | 57 |
| 2018 March | 99 | 6 | 105 |
| 2018 February | 32 | 5 | 37 |
| 2018 January | 31 | 4 | 35 |
| 2017 December | 41 | 13 | 54 |
| 2017 November | 36 | 6 | 42 |
| 2017 October | 27 | 6 | 33 |
| 2017 September | 43 | 20 | 63 |
| 2017 August | 30 | 13 | 43 |
| 2017 July | 30 | 23 | 53 |
| 2017 June | 32 | 23 | 55 |
| 2017 May | 58 | 16 | 74 |
| 2017 April | 41 | 20 | 61 |
| 2017 March | 47 | 39 | 86 |
| 2017 February | 27 | 23 | 50 |
| 2017 January | 0 | 13 | 13 |
| 2016 December | 0 | 16 | 16 |
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