New treatment for painful heel bumps.

These days, as ever, the sport of running comes with aches, pains, and conditions for which we seek immediate and long-term remedy. However, the bright future is always around the bend, with almost constant advancements in medicine that keep us going longer, stronger, and with less rehab time than ever before. Witness the new treatment for a common condition in runners known as Haglund's syndrome, an enlargement of the outside of the heel bone near the Achilles tendon. The condition results in a painful bump on the heel, but is frequently misdiagnosed as tendinitis.

As chief of Ultrasound and Body CT at the Hospital for Special Surgery in Manhattan, professor of Radiology at Cornell University Ronald Adler, MD, PhD, uses ultrasound guided injections of medication into the affected area, giving patients immediate and often lasting relief from Haglund's syndrome. Adler talks about the treatment in a peer reviewed article published in the February issue of the HSS Journal, in which he also differentiates among the surgical, blind injection, and (his preferred) ultrasound guided injection treatments available to Haglund's sufferers.

Essentially, surgery is often required but is not a desirable first step, while blind injections can cause tendon damage. Guided injections have been shown to alleviate the pain within hours of treatment, stave off pain for several days, and generally postpone and in many cases eliminate the need for surgery altogether.

The condition is common in runners because it is caused by the back of the shoe constantly rubbing against the heel. In addition to Achilles tendinitis, the condition is also sometimes mistaken for superficial irritation or inflammatory arthritis. Haglund's syndrome must be properly diagnosed to ensure that patients receive the appropriate treatment.

Once the diagnosis is confirmed, doctors use ultrasound to guide an injection of steroids directly into the affected area. "An ultrasound guided injection allows us to directly target the painful area or bursa, thereby avoiding an injection into the tendon," Adler reports. "This is the real advantage of ultrasound, since blind injections into the tendon can further weaken it, predisposing the tendon to rupture."

A surgical option requires longer rehabilitation, with several months of restricted activity. These are the words runners least like to hear. By contrast, Adler says, "Ultrasound is a nonsurgical outpatient procedure that does not require sedation and, when used in conjunction with modifications in footwear and activity, is an appropriate initial treatment for relief of the pain associated with this condition."

(HSS Journal, 2006, Vol. 2, No. 1, pp. 27-29)