Pain in the foot. 2. Causes of pain in the hindfoot, midfoot, and forefoot.

Pain in the foot has many causes. A careful history and physical examination, radiographs, and laboratory data usually yield the correct diagnosis so that specific treatment can be directed toward the problem to help relieve the patient's pain. Rarely is surgery necessary.

Xeroradiography in the diagnosis of the Haglund syndrome.

Xeroradiography is the radiographic method of choice for assessment of soft tissues and calcaneal detail in patients suffering from a painful swelling localized in the heel. The radiographic triad of retrocalcaneal bursitis, superficial tendo Achillis bursitis, and Achilles tendon thickening, in the presence of an intact posterior superior calcaneal margin, are readily evaluated with xeroradiography. The Haglund syndrome is a painful inflammation involving the two bursae which surround the Achilles tendon.

Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease).

Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result from post-traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with a normal Achilles tendon and superficial soft tissue contour, and intact cortex of the underlying os calcis.

The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications.

Haglund syndrome, a common cause of pain in the posterior heel, consists of a painful swelling of the local soft tissues (the so-called pump bump) and prominence of the calcaneal bursal projection. The condition is caused by compression of the distal Achilles tendon and surrounding soft tissue between the os calcis and the posterior shoe counter. Osseous plantar projections appear to be a critical etiologic factor in Haglund syndrome.

Aspiration of the retrocalcaneal bursa.

We aspirated the retrocalcaneal bursa in cadavers to determine the characteristics of bursal fluid. A small amount of clear, viscous fluid was constantly present in the bursa. Leucocyte count was low, and the mucin clot test was good.

Invasive retrocalcaneal bursitis: a report of three cases.

The authors describe three cases of retrocalcaneal bursitis, characterized by considerable local clinical symptomatology. The diagnosis was made clinically and confirmed histopathologically. In none of these cases, even after several years, did systemic rheumatic disease develop.

Partial calcaneal ostectomy for retrocalcaneal bursitis.

Heel pain in runners is very common. Retrocalcaneal bursitis may be disabling to the competitive runner. When conservative treatment fails, surgery (partial calcaneal ostectomy) may be indicated.

Posterior heel pain associated with a calcaneal step and Achilles tendon calcification.

Factors are examined which may be associated with chronic posterior heel pain of nonrheumatologic and nonmetabolic etiology. The charts of patients in whom Haglund's disease retrocalcaneal bursitis, or "pump bumps" was diagnosed during the period from 1963-1978 at The Hospital for Special Surgery, were reviewed. Nineteen patients met the criteria of symptomatic patients.

The Haglund syndrome: initial and differential diagnosis.

Haglund syndrome is a common cause of posterior heel pain, characterized clinically by a painful soft-tissue swelling at the level of the achilles tendon insertion. On the lateral heel radiograph the syndrome is characterized by a prominent calcaneal bursal projection, retrocalcaneal bursitis, thickening of the Achilles tendon, and a convexity of the superficial soft tissues at the level of the Achilles tendon insertion, a "pump-bump." An objective method for evaluating prominence of the bursal projection is measurement using the parallel pitch lines.

Surgical approaches to Haglund's disease.

The principle objective of this paper is to discuss the various surgical approaches and techniques utilized in excision of the prominent posterior-superior calcaneal exostosis.

Calcaneal abnormalities in articular disorders. Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Reiter syndrome.

The calcaneus of normal control patients, and those with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and Reiter syndrome was studied. Pathological abnormalities of the plantar aponeurosis, Achilles tendon, and retrocalcaneal bursa account for the radiographic alterations. In normal individuals, lateral radiographs show the thickness of the Achilles tendon to be not greater than 8 mm; the retrocalcaneal bursa creates a radiolucency which extends at least 2 mm below the superior surface of the calcaneus.

The painful heel. Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthrosis.

This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondylitis. On the other hand, sub-Achilles bursitis more frequently affected women with rheumatoid arthritis and rarely gave rise to severe talalgias.