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long-wind·ed (lông′wĭn′dĭd, lŏng′-) adj. 1. Wearisomely verbose: a long-winded speaker. See Synonyms at wordy. 2. Able to maintain breathing power during exertion: a long-winded swimmer. long′-wind′ed·ly adv. long′-wind′ed·ness n. American Heritage® Dictionary of the English Language, Fifth Edition. Copyright © 2011 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company. All rights reserved. long-winded adj 1. tiresomely long 2. capable of energetic activity without becoming short of breath ˌlong-ˈwindedly adv ˌlong-ˈwindedness n
A 61-year-old man presents with chronic pain of the right heel. A lateral x-ray of the calcaneus is taken.
This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.
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The arrows on the x-ray point to the following findings: A, os trigonum; B, Haglund deformity; C, superior
calcaneal osteophyte; and D, plantar calcaneal osteophyte. Achilles tendinitis and heel pain are frequently associated with calcaneal osteophytes, retrocalcaneal bursitis, and Haglund deformity.
Haglund deformity is an enlargement of the posterior superior and lateral calcaneal tuberosity. Irritation of the bony prominence results from rubbing of the rigid backs of shoes such as ice hockey skates, dress shoes, or women’s pumps (Haglund deformity is otherwise known as pump bump). The deformity will cause a noticeable bump on the back of the heel and retrocalcaneal bursitis as the heel rubs against the shoe.
Calcaneal bone spurs are associated with tight heel cords and plantar fasciitis. Os trigonum is an accessory ossicle of the posterior talus that is found in approximately 10% to 25% of patients.1,2 Os trigonum may cause posterior heel pain in patients who participate in activities that require extreme plantar flexion such as ballet dancing and soccer.3
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
- Myerson MS, McGarvey W. Disorders of the Achilles tendon insertion and Achilles tendonitis. Instr Course Lect. 1999;48:211-218.
- Hatch D. Achilles tendonitis. http://www.orthobullets.com/foot-and-ankle/7022/achilles-tendonitis. Updated August 23, 2015. Accessed January 8, 2016.
- Nault ML, Kocher MS, Micheli LJ. Os trigonum syndrome. J Am Acad Orthop Surg. 2014;22(9):545-553.
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