A 60 y.o. woman presented with pain in her heel
What does she have?
She is afebrile.
Our patient had Haglund syndrome. This is a prominent posterior superior exostosis. It is associated with insertional Achilles tendonitis and retrocalcaneal bursitis and is often painful.
Haglund’s exostosis
Kagers triangle, which is the region bordered by the superior part of the calcaneus, the Achilles tendon and the flexor hallucis longus tendon, is often obscured on xray. This is because inflammation of the fat pad behind the Achilles tendon occurs with the bony deformity.
Kagers triangle is not visible if there is Achilles tendonitis, bursitis of the retrocalcaneal bursa or Achilles rupture
The diagnosis and treatment of Haglunds can be made on US. US guided injection of the retrocalcaneal bursa can provide relief of pain. The cause of the bursitis is often felt to be due to wearing high heeled shoes; hence the name, “pump bump”. The differential diagnosis of pain behind the heel includes Reiter’s syndrome, and RA.
TRIVIA
High heels are defined as shoes in which the heel is over 3.5 cm, putting weight on the ball of the foot. High heels were first worn by Persian horsemen in the 10th century to help keep their feet in stirrups. Interestingly, they were exclusively worn by men. This trend continued in the 17th century in Europe where high heels became a sign of status. (No one who actually had to work for a living wore them). With the Enlightenment they were no longer worn but during WWII they made a comeback for women. Thanks to pin-ups in WWII and Playboy bunnies after that, high heels again became attractive.
Wearing high heels is strongly associated with injury . Falls , low back pain and foot pain result. Balance has been shown to be affected since wearing a high heel tilts the hips forward and pushes the buttocks out. Foot pain can come from plantar fasciitis, bunions, hammertoes, and Morton’s neuromas.
In Carmel-by-the-Sea, California, heels over 2 inches with less than one square inch of bearing surface can be worn only with a permit.
Men’s shoes
Sofka C, Adler R, Positano R, et al. Haglund’s sundrome: diagnosis and treatment using sonography. HSS J 2006 Feb;2(1):27-29.
Bell, Diane (11 September 2014). “Carmel high heel ban makes Ripley’s” (https://www.sandiegouniontribune. Com/sdut-carmel-eastwood-heels-ban-ordinance-ripley-book-2014sep10-story.html) San diego Union-Tribune.
Park K, Kim Y, Chung Y, et al Effects of the height of shoe heels on muscle activation of cervical and lumbar spine in healthy women. Journal of Physical Therapy Science. 28(3):956-59.
Tedeschi F, Wagner D, Nei R, et al. Influence of high-heeled shoes on venous function in young women. Oct 2012 Journal of Vascular Surgery 56(4):1039-1044.