The Role of Haglund Deformity and Calcaneal Morphology in Insertional Achilles Tendinopathy: Radiographic Analysis in a Matched Surgical Cohort.

Abstract

Insertional Achilles tendinopathy (IAT) is commonly associated with radiographic abnormalities at the Achilles insertion, including Haglund deformity, enthesophytes, and intratendinous calcification. However, the relationship between IAT and these radiographic features remains unclear. To compare the radiographic features of patients with surgically treated IAT with those of asymptomatic controls. Retrospective comparative study METHODS: Thirty-seven patients who underwent surgery for unilateral IAT were matched by age, gender, and BMI to 37 controls with unrelated forefoot or midfoot pathology. Lateral radiographs were assessed for Fowler-Philip angle (FPA), parallel pitch lines (PPL), X/Y ratio, intratendinous calcification, and posterior calcaneal spur. IAT patients showed higher mean FPA (62.3° vs 54.0°, p < 0.001), lower X/Y ratio (2.59 vs 2.76, p = 0.022), and greater PPL positivity (95% vs 57%, p < 0.001). Intratendinous calcification (70% vs 30%, p < 0.001) and posterior calcaneal spur (89% vs 73%, p = 0.037) were more common in IAT. Radiographic indicators of Haglund's deformity, calcaneal morphology and calcific changes are significantly associated with IAT, supporting their diagnostic and etiologic relevance.