Journal of foot and ankle research · 2026
Haglund Deformity and Plantar Calcaneal Spur in Insertional Achilles Tendinopathy: Prevalence, Coexistence, and Radiographic Characteristics.
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Dadir İbrahim Halil
Аннотация
BACKGROUND: Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain and has been associated with several osseous abnormalities around the calcaneus. Although Haglund deformity and plantar calcaneal spur (PCS) have each been linked to IAT, their coexistence and radiographic characteristics have not been comprehensively evaluated. This study compared the prevalence of Haglund deformity and PCS between patients with IAT and controls, assessed their coexistence, and examined radiographic features associated with IAT.
METHODS: This retrospective case-control study included 224 adults who underwent weight-bearing lateral ankle radiography between January 2022 and January 2024, comprising 107 patients with clinically diagnosed IAT and 117 controls. The presence of Haglund deformity and PCS, PCS length, Fowler-Philip angle, Brink angle, and calcaneal pitch angle were evaluated. Multivariable logistic regression analysis was performed to identify factors independently associated with IAT.
RESULTS: Haglund deformity (65.4% vs. 15.4%, p < 0.001) and PCS (64.5% vs. 18.8%, p < 0.001) were significantly more prevalent in patients with IAT than in controls. Their coexistence was also more common in the IAT group (50.5% vs. 6.0%, p < 0.001), and PCS length was greater (p < 0.001). No significant differences were observed in Fowler-Philip angle, Brink angle, or calcaneal pitch angle. After multivariable adjustment, Haglund deformity (adjusted OR, 7.86; 95% CI, 3.75-16.48; p < 0.001), PCS (adjusted OR, 3.97; 95% CI, 1.94-8.13; p < 0.001), and higher body mass index (adjusted OR, 1.11; 95% CI, 1.05-1.18; p < 0.001) remained independently associated with IAT.
CONCLUSIONS: Haglund deformity and PCS were independently associated with IAT and frequently coexisted in affected patients. These findings suggest that multiple structural abnormalities may occur concurrently at the calcaneal enthesis. Combined radiographic assessment of Haglund deformity and PCS may improve the evaluation of patients with IAT.
METHODS: This retrospective case-control study included 224 adults who underwent weight-bearing lateral ankle radiography between January 2022 and January 2024, comprising 107 patients with clinically diagnosed IAT and 117 controls. The presence of Haglund deformity and PCS, PCS length, Fowler-Philip angle, Brink angle, and calcaneal pitch angle were evaluated. Multivariable logistic regression analysis was performed to identify factors independently associated with IAT.
RESULTS: Haglund deformity (65.4% vs. 15.4%, p < 0.001) and PCS (64.5% vs. 18.8%, p < 0.001) were significantly more prevalent in patients with IAT than in controls. Their coexistence was also more common in the IAT group (50.5% vs. 6.0%, p < 0.001), and PCS length was greater (p < 0.001). No significant differences were observed in Fowler-Philip angle, Brink angle, or calcaneal pitch angle. After multivariable adjustment, Haglund deformity (adjusted OR, 7.86; 95% CI, 3.75-16.48; p < 0.001), PCS (adjusted OR, 3.97; 95% CI, 1.94-8.13; p < 0.001), and higher body mass index (adjusted OR, 1.11; 95% CI, 1.05-1.18; p < 0.001) remained independently associated with IAT.
CONCLUSIONS: Haglund deformity and PCS were independently associated with IAT and frequently coexisted in affected patients. These findings suggest that multiple structural abnormalities may occur concurrently at the calcaneal enthesis. Combined radiographic assessment of Haglund deformity and PCS may improve the evaluation of patients with IAT.