Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chronic, symptomatic bony prominence at the posterior-superior aspect of the calcaneus. Reports localized pain exacerbated by rigid-backed footwear and physical activity. Denies acute trauma. Symptoms are consistent with retrocalcaneal bursitis and insertional Achilles tendinopathy secondary to Haglund's deformity.
Clinical Examination Findings
Inspection reveals a prominent posterior-superior calcaneal exostosis. Palpation demonstrates significant tenderness at the retrocalcaneal recess and the Achilles insertion. Skin overlying the prominence shows signs of chronic irritation, erythema, or hyperkeratosis. Range of motion of the ankle is within functional limits, though dorsiflexion may be restricted by pain. No signs of infection or neurovascular compromise.
Treatment Protocol
Conservative management initiated: modification of footwear (open-back or soft-heel counter shoes), activity modification, and use of heel lifts or orthotics to reduce retrocalcaneal pressure. Prescribed NSAIDs for inflammation and physical therapy focused on eccentric Achilles strengthening and gastrocnemius stretching. If refractory, consider corticosteroid injection (with caution regarding tendon rupture) or surgical exostectomy.