About dynamic ultrasound and Mri study of Haglund’s syndrome

Pain at the back of the heel is the clinical presentation of Haglund’s syndrome; Achilles tendinophaty, bony enlargement on posterosuperior aspect of calcaneum and retrocalcaneus bursitis are the main characteristics of this painful syndrome, also associated with calcaneal spurs.  Repetitive impingement microtraumas lead to Achilles tendon degeneration.

I always perform both ultrasound and Mri examinations; direct visualization of the impingement syndrome allows to better estimate the tendon damages and all associated painful conditions, such as the retrocalcaneal bursitis.

Don’t forget to take a look at the Kager’s fat pad triangle; on ultrasound exam its echogenicity need to be the same or inferior than Achilles tendon appearance.

In this patient hyperechogenicity of Kager’s triangle is evident, due to its chronic involvement in the inflammatory process.

From left to right: Sagittal T1w – Xbone T1w and Ge Stir Mri sequences of the same patient (0.3 Tesla).

The Mri exam also shows a stress fracture of the posterosuperior corner of the calcaneus.

The site of impingement is better demonstrated also with the Mri dynamic examination.