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Answer:

Haglund syndrome.

Findings

  • Conventional lateral radiograph of the foot demonstrates deformity of the posterior-superior calcaneus with adjacent soft tissue swelling.

  • MRI of the hindfoot demonstrates bony prominence of the calcaneal tuberosity with retrocalcaneal bursitis and minimal insertional achilles tendinopathy.

Differential Diagnosis
  • Haglund syndrome
  • Stress fracture
  • Enthesopathy
  • Rheumatoid arthritis

Discussion

Haglund syndrome is a relatively common finding in middle-aged women who wear high-heeled shoes and present with discretely painful prominent soft tissue swelling over the heel, or "pump bump."

The associated radiographic findings include the triad of prominent posterior calcaneal tuberosity, insertional achilles tendinopathy, and retrocalcaneal and/or retroachilles bursitis.

This constellation of findings occurs secondary to constant rubbing of the posterior aspect of the calcaneus against the stiff heel cups found in high-heeled shoes.

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