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Case of the Season #3

Patient: Female, 14 years, 105 lbs

 

Complaints

 

Redness, pain and swelling on the back of both feels, several months duration.

 

History

 

Negative- no specific history of injury. Pain is present especially in closed back shoes (slip on and pump styles).

 

Clinical observations

 

Soft tissue swelling and inflammation is apparent. Pain is elicited on palpation of the superior postero-lateral margin of the calcaneus.

 

Diagnosis

 

Haglunds deformity with acute posterior calcaneal bursitis.

 

Discussion

 

Haglunds deformity is found most commonly in females in association with a subtalar varus deformity. The calcaneus in a subtalar varus foot is inverted with respect to the leg when the foot is in a neutral position. So the superior postero-lateral margin of this bone is in contact with the heel counter of the shoe. Consequently, when the subtalar joint pronates, bringing the foot to the ground, the calcaneus moves in the direction of eversion. This causes impingement of soft tissue between the calcaneus and the heel counter, resulting in friction, inflammation, swelling and pain.

 

Management

 

For relief of acute symptoms:

a)     Physiotherapy

b)     Injection of steroids

c)      Elevation of the heels via pads in the shoes

 

For long term management:

a)     Biomechanical functional orthotics with a rearfoot varus post of control pronation

b)     Surgical intervention coupled with orthotic control if the contour of the superior postero-lateral border of the calcaneus is excessively enlarged or distorted

 

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