Things to Do in Embu das Artes - Tripadvisor https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/, https://www.ouh.nhs.uk/patient-guide/leaflets/files/11924Ptendinopathy.pdf, https://www.youtube.com/watch?v=vygmqXru4yc, https://pubmed.ncbi.nlm.nih.gov/25179453/, https://www.sciencedirect.com/science/article/pii/S1083751517300773, https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_foot-and-ankle.pdf, https://www.acfas.org/footankleinfo/haglunds-deformity.htm, https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=1862, https://radiopaedia.org/articles/haglund-syndrome?lang=gb, https://www.saintlukeskc.org/health-library/leg-and-knee-exercises-heel-raise, https://www.sciencedirect.com/science/article/pii/S1048666618300211, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349338/, https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101401/, New clues to slow aging? We include products we think are useful for our readers. Diagnostic significance of radiologic measurements in posterior heel pain. Heel bursitis can also affect those who have other disorders, including: Haglund's deformity. Cureus. An atlas of foot and ankle surgery. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Heel pain can range from mild to disabling. HSS J. Haglund's deformity, or "pump bump" is a common cause of posterior heel pain, characterized clinically by a painful soft tissue swelling at the level of the Achilles tendon insertion. They may also use diagnostic tests, such as an X-ray, MRI, or ultrasound, to evaluate the shape of the heel bone and determine the severity of the condition. Achilles Tendinitis - OrthoInfo - AAOS from. foothealthfacts.org/footankleinfo/haglunds-deformity.htm, apma.org/Learn/FootHealth.cfm?ItemNumber=1862, orthogate.org/patient-education/foot/haglunds-deformity-of-the-foot.html, aofas.org/footcaremd/treatments/Pages/Haglund%E2%80%99s-Deformity-Surgery.aspx, Everything You Need to Know About Heel Spurs, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Plantar Fasciitis Stretches to Soothe Heel Pain, Recognizing and Treating Common Foot Problems, severe pain in the area where your Achilles tendon attaches to your heel, swelling in the bursa, which is the fluid-filled sac at the back of your heel, taking nonsteroidal anti-inflammatory drugs (. 2022;14(7):e275002. [2] The population is 276,535 (2020 est.) To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. A sudden increase in walking, running or jumping can cause heel bursitis. Conservative management of Hugland's deformity is used to relieve the associated symptoms, but it cannot resolve the problem. Debridement is a term that refers to the removal, or "cleaning up," of damaged tissue. Haglund's deformity can develop into a painful heel condition known as Haglunds syndrome. Pain in the Achilles region. De Embu das Artes para So Paulo - Existem 4 maneiras de - Rome2rio However, if your surgeon chose to use sutures that dissolve, you won't need to have the stitches taken out. Many surgeons simply remove the bump. These removable braces work by holding your foot in place with your toes pointing upward (similar to the calf stretch position) while you sleep. Other minimally invasive surgeries include using small holes to release parts of the tendon and muscle from the bone. Wearing shoes that have proper arch support for people with high arches. Here are several potential causes of Haglunds deformity: A tendency to walk on the outside of the heel A tight Achilles tendon High arches Many times, these defective foot structures are inherited. Finding a qualified health professional who treats foot pain is key to managing discomfort and may help prevent other aspects of Haglunds syndrome, such as bursitis. (2005). Radiology. Haglund deformity | Radiology Case | Radiopaedia.org A persons natural foot structure may sometimes make them more prone to the condition. Sit on the floor with both legs out in front. 2023 Healthline Media UK Ltd, Brighton, UK. In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon (above where it attaches to the heel) are affected. RACGP - The Achilles tendon Achilles tendinitis pain can occur within the tendon itself or at the point where it attaches to the heel bone, called the Achilles tendon insertion. Many patients require up to 12 months of rehabilitation to reach maximum improvement. In most cases of Achilles tendinitis, nonsurgical treatment options will provide adequate pain relief, although it may take a few months for symptoms to completely subside. If your pain is severe, your doctor may recommend a walking boot for a short time. Haglund's deformity is a bony bump where your Achilles tendon attaches at the back of your heel bone. 1994;25 (1): 41-6. Surg Radiol Anat. Surgery to treat Haglund's deformity is typically done as an outpatient procedure, meaning you will be able to go home on the same day of surgery. Abnormalities in foot function, position, or a genetic predisposition may also contribute to the condition. The calcaneus is shaped differently in different people. This type of surgery is generally considered safe and has a high success rate. They include: A doctor may identify Haglunds deformity by looking at the heel and discussing a persons symptoms. Patients present with pain centered around the heel and the Achilles insertion. Conservative management includes management of the inflammation, modification of aggravating factors and an eccentric training programme. The mainstays of nonsurgical treatment include anti-inflammatory pain medications, activity modification, shoe wear modification, and physical therapy exercises. This makes the bump larger and increases your pain. Thank you, {{form.email}}, for signing up. A foam cup filled with water and then frozen creates a simple, reusable ice pack. These exercises may cause some discomfort, but it should not be unbearable: Cortisone, a type of steroid, is a powerful anti-inflammatory medication. Case - Bilateral Haglund Deformity - orthobullets.com (2017). Wlker N, Stephens M, Cracchiolo A. 2013;200 (4): 845-55. $170.00. [4] Cavo varus deformities exacerbate this problem. You may also be more at risk for getting Haglunds deformity if you have a high foot arch, have a tight Achilles tendon, or tend to walk on the outside of your heel. Telephone: 410.494.4994, Operative management of Haglund's deformity in the non athlete: a retrospective study, Chronic retrocalcaneal bursitis treated by resection of the calcaneus, Prominence of the calcaneus: late results of bone resection, Orthopaedic Specialists of North Carolina. Haglund syndrome can present both unilaterally and bilaterally. Those most often linked to this problem have a stiff back and include: You may start by seeing your primary healthcare provider, who might refer you to a foot specialist known as a podiatrist. Achilles tendinopathy: Advice and management. Your doctor might be able to diagnose the condition based on the appearance of your heel. Available from: I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. This website also contains material copyrighted by third parties. Haglund's deformity, or "pump bump," is a common cause of posterior heel pain. This can be done for up to 20 minutes at a time, but the ice should be removed sooner if the skin becomes numb. Haglund's deformity of the foot. Unable to process the form. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Haglund deformity an enlargement of the posterosuperior tuberosity of the calcaneus Epidemiology demographics more common in young patients Physical exam pain localized to anterior and 2 to 3 cm proximal to the Achilles tendon insertion fullness and tenderness medial and lateral to tendon pain with dorsiflexion bony prominence at Achilles insertion With this, the bony deformity is accompanied by bursitis and Achilles tendinosis. People who have a prominent bump underneath the attachment of the Achilles tendon are more likely to develop Haglund's deformity. You can lower your risk of developing Haglunds deformity by taking care of your feet: With proper treatment, your pain should go away. Doctors also talk about Haglunds syndrome, which involves three conditions: Some people have features, such as the shape of their foot, which increases the risk of developing Haglunds deformity and Haglunds syndrome. View Manchikanti Venkatesh's current disclosures, View Abdulmajid Bawazeer's current disclosures, see full revision history and disclosures. This procedure is performed much the same as removing the bump. Deformity is more apt to be unilateral, and treatment is often necessary. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Examples include ultrasound, moist heat, and soft-tissue massage. Wheeless' Textbook of Orthopaedics. However, the bone lump will not shrink. Sometimes a magnetic resonance imaging (MRI) scan may be ordered as well. This X-ray shows calcification within the Achilles tendon in severe noninsertional Achilles tendinitis. Haglund's deformity usually develops due to shoes rubbing up against the heel. Haglund's Deformity Surgery | FootCareMD PDF Haglund's Resection - Medical College of Wisconsin In fact, the deformity does occur in young women who wear pumps but does not exclusively occur in that population. From the RSNA Refresher Courses. Seyed B. Mostofi. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope an instrument that contains a small camera. The bone may also be smoothed and filed down. Ice/cryotherapy helps deal with swelling. Foot (Edinb). 6. Haglund's Deformity Symptoms. A physical therapist or nurse may teach you how to properly use your crutches. At the time the article was created Frank Gaillard had no recorded disclosures. Repeat this exercise 20 times for each foot. Haglund's deformity usually develops due to shoes . Lawrence DA, Rolen MF, Morshed KA et-al. Chauveaux D, Liet P, Huec J et-al. Catherine Moyer, DPM, is a podiatrist experienced in the diagnosis, treatment, and prevention of disorders of the foot and ankle. We find that most patients have a gradual onset of both pain and swelling. People cannot avoid Haglunds deformity in every case. It is typicallyused for patients with diagnostic uncertainty to better assess soft tissues. This will help your doctor determine whether you have the prominent heel bone associated with the disease. Treatment is typically physiotherapy in conjunction with guided corticosteroid injections into the retrocalcaneal bursa. Embu das Artes, previously and commonly known simply as Embu, is a Brazilian municipality in the State of So Paulo. Diagnosis is made clinically with presence of a prominence on the lateral aspect of the 5th metatarsal head, often associated with pain and callus formation. It is frequently caused by calf muscle tightness, which places increased stress on the Achilles tendon insertion. Avoid shoes with tight, stiff heels, especially for long periods of time. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse. Read our, What Are the Symptoms of Haglund's Deformity. - patients are immobilized for four weeks. This can cause swelling and thickening of the tissues, which makes the pressure even worse. Eccentric Strengthening. Embu das Artes Postal address. As an integral part of your everyday life, your feet experience a lot of wear and tear. The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study [published correction appears in Bone Joint Res. Ultrasound findings are similar to MRI and depend on availability and referrer preference. Severely restricted ankle joint mobility. 2008;18 (2): 91-8. Learn more here. The incision is closed with stitches, and you are placed in a bulky bandage to protect the foot while it heals. Informa HealthCare. - patients note posterolateral prominence and tenderness; Haglunds deformity can affect the Achilles tendon by pushing on it, but a posterior heel spur can grow into the tendon, which may develop calcifications. A noticeable bump or an enlarged bony prominence on the back of the heel. The large Achilles tendon attaches to the back of the calcaneus. A range of factors. This area is especially aggravated by women's closed high-heeled shoes. Achilles tendon rupture typically results from a sudden injury. Roche AJ, Calder JDF. If conservative treatment is not effective then following surgical treatment options are considered. Perform stretching exercises to prevent tightening of the Achilles tendon. Common symptoms of Achilles tendinitis include: If you have experienced a sudden pop in the back of your calf or heel, you may have torn your Achilles tendon. You might get recommendations on shoes that keep pressure off the sore area. Stretching correctly before and after exercise, especially the calves, Achilles tendon, and feet. Haglunds deformity is a bony bump or ridge that appears on the back of the heel bone, where the Achilles tendon attaches to the heel. To our knowledge, no study has been done successfully correlating the characteristics of a Haglund's deformity with insertional Achilles tendinitis. These can be the sites of inflammation and can develop bursitis. Orthotics are customized shoe inserts made to stabilize your foot. Does Haglunds deformity go away on its own? In 2015, some researchers found that, in X-ray images, the angle between the sole of the foot and the base of the heel bone tended to be greater in people with Haglunds deformity. However, not everyone with the bony lump will encounter all three conditions. MRI is also used for patients with diagnotic uncertainty to better assess soft tissues. The plantar fascia is a thin ligament that connects your heel to the front of your foot. no financial relationships to ineligible companies to disclose. This deformity leads to retrocalcaneal bursitis. Eccentric strengthening is defined as contracting (tightening) a muscle while it is getting longer. - excision must be kept proximal to the achilles insertion; Related Document: A Patient's Guide to Foot Anatomy. - average size of the excised fragment is 3 cm wide, 3 cm long, and 6 mm thick; Data Trace Publishing Company Modification of aggravating factors to minimize friction between. A Haglund's deformity is an enlarged or prominent bump in the back of the heel bone. Brasil. p.795-797. This measurement helps to identify patients with Haglund syndrome and patients predisposed to develop this condition, and also to differentiate local causes of posterior heel pain from systemic causes. For example, shoes that are softer or open at the back of the heel can reduce irritation of the tendon. If the Achilles tendon requires any form of repair, weight bearing may be delayed and you will need to wear a special boot with a heel lift. Towson, MD 21204 However, more information is needed before strong recommendations can be made for its routine use. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Inflammatory. Haglund deformity | Radiology Reference Article | Radiopaedia.org It may be visible, and calcifications can develop here. 2006;2 (1): 27-9. the Haglund's deformity were indicated; - Non Operativer Treatment: 1998;80(12):1814-1821 5. It is also common in runners.[7]. Once the unhealthy portion of the tendon is removed, the remaining tendon can be reattached to the heel bone. Staying out of shoes as much as possible will usually reduce the inflammation and the bursitis due to Haglund's deformity. http://www.aofas.org/PRC/conditions/Pages/Conditions/Haglund-Deformity.aspx, https://midwestbonejoint.com/foot/haglunds-deformity-of-the-foot/, https://www.healthline.com/health/haglund-deformity, https://www.mcw.edu/-/media/MCW/Departments/Orthopaedic-Surgery/hagland.pdf?la=en, http://www.oregonmedicalgroup.com/wp-content/uploads/2015/07/1f43c091d17ec4f2d9902a5687e39819.pdf, https://www.physio-pedia.com/index.php?title=Haglund%27s_deformity&oldid=313363. It may be caused by wearing shoes that are too tight or stiff in the heel. Ancient practices and a growing body of medical research suggest that massaging pressure points on your feet can heal conditions on different parts of. Surgical treatment for Haglund's deformity - PubMed Tight-fitting shoes can cause heel bursitis. Haglund's deformity is an enlargement of the posterosuperior prominence of the calcaneus, which is frequently associated with insertional Achilles tendinitis. These techniques may become more popular with time, but there is still limited information on their effectiveness. - inflammation can be related to a Haglund deformity (postero-superior prominence - normal varient) which causes an overlying bursitis; Foot and ankle disorders. Available from: Medical College of Wisconsin. The origin of a Haglund's deformity is debated in the literature. Haglund's deformity which is an enlargement of the posterosuperior prominence of the calcaneum and/or calcaneal spurs 7. The primary symptoms are: When the bony lump of Haglund's deformity rubs against shoes, it can cause other nearby tissues to become inflamed. What are the symptoms of Haglunds deformity? AJR Am J Roentgenol. Both Haglunds deformity and heel spurs can cause pain in the back of the foot, but they are not the same. Nonsurgical options include: Surgery can also be used to treat Haglunds deformity if less invasive methods dont work. Hold for 510 seconds, and then slowly lower the heels to the ground. We avoid using tertiary references. Since it often develops in women. Prominence of the calcaneus: late results of bone resection. a tight Achilles tendon, which may put pressure on the heel bone. Seyed B. Mostofi. These tests can also help your doctor ascertain the severity of your Achilles tendinitis. Haglund's deformity is an alteration in the morphology of the calcaneus, which forms a vertical bony extension in the posterior superior tuberosity. The stitches are generally removed in 10 to 14 days. Haglund syndrome is a painful condition of the heel and its diagnosis requires a combination of clinical and radiological findings 8. Haglund's deformity and retrocalcaneal bursitis. It does not always involve calcifications, but these can result if Haglunds deformity leads to chronic inflammation. Stephens MM. What can be done for a Haglund's deformity? Non-steroidal anti-inflammatory drugs (NSAIDs), Haglunds syndrome: a commonly seen mysterious condition, The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study [published correction appears in Bone Joint Res. However, extended use of a boot is discouraged because it can weaken the calf muscle. The primary cause of the problem is shoe wear. J Foot Surg. Using a step, a person can combine the heel raise and heel drop exercise, as in the image below: Haglunds deformity can cause symptoms that range from mild to severe. Ask the patient to avoid shoes with rigid back. They do not, however, reduce the thickening of the degenerated tendon. Embu das Artes, So Paulo, Brazil - City, Town and Village of the world Haglunds deformity is a symptomatic osseous prominence of the posterolateral corner of the calcaneus resulting in posterior heel pain and swelling around the insertion of the Achilles Tendon. - lateral approach is easier but care must be taken to avoid sural nerve; It may be caused by wearing shoes that are too tight or stiff in the heel. At the time the article was created Manchikanti Venkatesh had no recorded disclosures. To help avoid Haglund's deformity and optimally protect the feet, IPFH suggests wearing only properly selected and fitted, as part of an integrated approach, padded sockswith shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Catherine Moyer, DPM, is a podiatrist experienced in the diagnosis, treatment, and prevention of disorders of the foot and ankle. Mild cases usually involve episodic pain after long periods of inactivity. BJSTR. Also see the pages for Achilles tendinosis and retrocacaneal bursitis for more information on the management thereof. Haglund deformity. (11) 4785-3500. International: +55 11 4785-3500. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Hammer toe is a condition where one of the toes becomes stiff and bent, in a position resembling the shape of a hammer. [2] [3] It is associated with retrocalcaneal bursitis. Embu das Artes - Wikipedia Complications associated with Haglund's deformity surgery include: If only the bony deformity is removed, you should expect to have a non-weight bearing cast on, meaning you can't walk, for about two weeks. Tendinitis, tendinosis, and tendinopathy are all common terms which essentially refer to the same problem. Original Editors - Nick Despeghel, Jonathan Hoof, Gertjan Pauwels and Wout Lippens, Top Contributors - Niha Mulla, Leana Louw, Kim Jackson, Wout Lippens, Kalyani Yajnanarayan and Claire Knott, Haglunds deformity is defined as an abnormality of the bone and soft tissues in the foot where an enlargement of the bony section of the heel where the Achilles tendon inserts is triggered. The two types can occur separately or at the same time. doi:10.26717/BJSTR.2021.35.005759, Agyekum EK, Ma K. Heel pain: A systematic review. (2018). {"url":"/signup-modal-props.json?lang=us"}, Venkatesh M, Bawazeer A, Niknejad M, et al. No wonder many of us end up with tired, achy, and stinky feet. Most authors believe that a Haglund's deformity forms as a . Over time the thickened tissues will shrink back to near normal size if the pressure is removed. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-25489. Lawrence DA, Rolen MF, Morshed KA et-al. Last medically reviewed on January 6, 2022, The Achilles tendon runs down the back of the lower leg and joins the calf muscles to the heel bone. 2. Pain that worsens when walking (especially in pumps or dress shoes) Redness and swelling of the heel. Prefeitura Municipal de Embu. Endoscopic surgery is less invasive than traditional surgery. Haglund's deformity: Treatment, exercises, pictures, and causes Only surgery will remove the additional once it develops. Haglund's deformity occurs when there's frequent pressure on the backs of your heels. You may also come across the term "tendinopathy," which is used to describe a condition in which the tendon develops microscopic degeneration as a result of chronic damage over time. At the time the article was last revised Joshua Yap had In the vast majority of cases, treatment usually begins with nonsurgical measures. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Bursae are found in many places in the body where tissues must move against one another. Gastrocnemius recession has also shown good results, with high rates of reduced pain and improved function after surgery. Haglund's deformity is a condition where a bony enlargement on the back of the calcaneus develops. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Glossary of terms for musculoskeletal radiology, Preventative aspects of muscle displacement in the running athlete, Surgical treatment of Haglunds deformity: a systematic review and meta-analysis, Haglund's syndrome: A commonly seen mysterious condition, A noticeable bump on the back of the heel, Blisters and/or callouses on and around the bump due to increased friction from shoes, Abnormal foot biomechanics due to joint misalignment, Stretching exercises for the Achilles tendon, Heel lifts to decrease pressure on the bone for people with high arches, Immobilization, such as with a cast or soft boot to allow it to heal. Haglund's deformity is often called "pump bump" because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. Stand with feet flat on the floor and both hands on a wall or holding the back of a chair for support. Faria Lima, 682 para Terminal Bandeira 6262-10 Treatment of Haglund's deformity can be divided into nonsurgical treatment and surgical treatment. The Haglund syndrome: initial and differential diagnosis. This study presents a retrospective study of 65 cases (53 patients), with symptomatic Haglund's deformity in nonathletes (13 male and 40 female), who p Generally no other tests are required. Noninvasive therapies often help relieve pain in mild cases. Bend the knee of one leg, bringing the foot up behind you, so your body weight is on the standing foot. - diff dx: achilles tendinitis. [7], Hugland's Deformity are most common in the female population between the ages of 15 and 35, especially in woman who regularly wear heels. Disorders of the Achilles tendon and the retrocalcaneal region. Common Superficial Bursitis | AAFP It is a result of overuse. Haglund deformity may result from the chronic pressure of rigid shoes. Ultrasound has grown in popularity among physicians in recent years. It is associated with calcaneal spurs, and the wearing of high heels (hence the colloquial term "pump-bump") or stiff-backed shoes in general. Become a Gold Supporter and see no third-party ads. Understanding the pathologic Haglund's deformity. Inflammation is noted at the insertion of the Achilles tendon, posterior heel, and in the retrocalcaneal bursa. According to the American College of Foot and Ankle Surgeons, stretching exercises can help relieve tension in the Achilles tendon, especially in people with a tight heel cord. It is also called: Haglund's deformity usually appears on both feet, rather than just one. Clin. X-rays provide clear images of bones. Surgery for retrocalcaneal bursitis: a tendon-splitting versus a lateral approach. Osteochondroma of the calcaneus presenting as Haglunds deformity. Insertional Achilles tendinitis involves the lower portion of the tendon, where it attaches (inserts) to the heel bone (also known as the calcaneus). Insertional Achilles tendinitis is often relieved by certain shoes and orthotic devices. Radiological Society of North America. This article discusses how to manage Haglunds deformity and why it happens. 2. Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Disorders of the Insertion of the Achilles Tendon and Achilles Tendinitis. MRI of heel pain. (n.d.). Haglund's deformity. The risk of achilles tendon rupture in the patients with achilles tendinopathy: healthcare database analysis in the united states. Regis Bittencourt km 2809 norte - Parada Jardim Sadie - Jardim Sadie Embu das Artes - SP 06803-470 Brasil para R. Pedro Cristi 38 - Pinheiros Sao Paulo - SP 05421-040 Brasil 032 / . Last medically reviewed on August 16, 2017. Your doctor will likely give you a boot or cast to protect your foot. - prominence of the posterior superior calcaneal tuberosity contributes to inflammation of the overlying tissues and the Achilles tendon; You may also need to use crutches for a few days or weeks. Pain and tendon thickening at insertion of Achilles tendon, occurs in middle-aged and elderly patients with a tight heel cord, repetitive trauma leads to inflammation followed by cartilagenous then bony metaplasia, lateral foot shows bone spur and intratendinous calcification, locked ankle AFO for 6-9 months (if other nonoperative modalities fail), avoid steroid injections due to risk of Achilles tendon rupture, failure of nonoperative management and < 50% of Achilles needs to be removed, midline, lateral, or medial J-shaped incisions, when > 50% of Achilles tendon insertion must be removed during thorough debridement, heavier patients with more severe disease, FHL transfer has been associated with increased ankle plantar flexion, Retrocalcaneal bursitis & Haglund deformity, is inflammation of the bursa between the anterior aspect of the Achilles and posterior aspect of the calcaneus, an enlargement of the posterosuperior tuberosity of the calcaneus, 2 to 3 cm proximal to the Achilles tendon insertion, fullness and tenderness medial and lateral to tendon, lateral of foot demonstrates Haglund deformity, disease refractory to nonoperative management, imbalance of dorsiflexors and plantar flexors, thought to be caused by anaerobic degeneration in portion of tendon with poor blood supply, tendon thickening and tenderness 2 to 6 cm proximal to Achilles insertion, chronic rupture will show a hypoechoic region between tendon ends, nonoperative management is 65% to 90% successful, evolving indications due to lack of evidence at this time, longitudinal tenotomy made in the degenerative area, strip the anterior Achilles tendon with a large suture to free any adhesions, open excision of degenerative tendon with tubularization, degeneration of >50% of the Achilles tendon, subacute rupture in the setting of prior achilles tendinopathy, Posterior Tibial Tendon Insufficiency (PTTI).