Page 4
Radiology
(Click images for larger versions.) 
(Above) Lateral radiograph shows (+) parallel pitch line (PPL) in a patient with Haglund syndrome referring to prominence of the calcaneal tuberosity and bursal projection.
- (Green line) Lower PPL (PPL1) is baseline, constructed as for posterior calcaneal angle
- (Yellow lines) Perpendicular is constructed between posterior lip of talar articular facet (T) and baseline
- (Red line) Upper PPL (PPL2) drawn parallel to baseline
- Bursal projection (BP) touching or below PPL2 is normal: (-) PPL
Treatment is typically conservative and includes adding heel lifts, wearing open-backed shoes, limiting ambulation, and heel cord stretching exercises. Nonsteroidal anti-inflammatory medications and ice therapy are also recommended. Steroids are not routinely prescribed, as there is an increased risk of achilles tendon rupture. In severe cases, surgical excision of the calcaneal tuberosity is indicated.
Key Points
- Haglund deformity is predominantly seen in middle-aged women who frequently wear high-heeled shoes and present with painful soft tissue swelling, or "pump bump," over the heel of the foot.
- Triad of radiological findings includes prominent posterior calcaneal tuberosity, thickened achilles tendon at its insertion point, and retrocalcaneal and/or retroachilles bursitis.
- Treatment is typically conservative and includes NSAIDs and ice therapy, heel cord stretching exercises and wearing open-backed shoes rather than high-heeled shoes.
We welcome your feedback, please send questions and comments to Marcel Maya, MD
