Haglund's deformity and retrocalcaneal bursitis.

An excessive prominence of the bursal projection in the posterosuperior aspect of the calcaneous constitutes Haglund's deformity. Swelling in this area constitutes Haglund's disease and is associated with retrocalcaneal bursitis. Rigid and prominent heel counters with high heels impinge on the soft tissues overlying the prominence and give rise to symptoms of pain and swelling. Cavo varus deformities exacerbate this problem. The bursal projection can be demonstrated radiologically by a superior calcaneal angle of more than 75 degrees, a combination of calcaneal inclination and a posterior calcaneal angle of more than 90 degrees, and excessive bone above the upper parallel pitch line. Conservative treatment should always be implemented, and only those that have not benefited from such therapy should be considered for surgery. The results of surgery are satisfactory, provided adequate bone has been resected and no damage to local peripheral nerves or the Achilles tendon has been sustained. After a period of immobilization, an appropriate rehabilitation program must complement the treatment to ensure the early return of function to the tendons and surrounding joints.