Haglund’s Deformity Surgery

What is a Haglund’s deformity? 

A Haglund’s deformity is a bump back of the heel bone. The Achilles tendon runs over the bump. Patients with a Haglund’s deformity may or may not have pain. Sometimes, this bump pain is due to the friction that occurs from shoes. At other times it can be part of pain of degeneration in the Achilles tendon due to the pressure placed there. It is not always clear how much of this Achilles tendon problem is due to the Haglund’s deformity.
 

What are the goals of surgery for a Haglund’s deformity?

If prominence is the main issue, then the goal of surgery is simply to make the heel bone not as prominent. If there is also Achilles tendon degeneration present, then the procedure may involve the Achilles tendon directly as well.

 

What signs indicate surgery might be needed?

Pain that is not responsive to non-operative treatment is the central feature that should make someone consider a surgery. If the Achilles tendon is degenerative, there may be a risk of rupturing the tendon. However, that risk is not very high.
 

When should I avoid surgery?

The surgery is performed for pain that does not respond to more conservative measures. It makes sense to exhaust conservative measures before considering a surgery such as this one.  Also, patients at high risk for wound issues should strongly consider avoiding surgery.
 

General Details of the Procedure

For anesthesia, the patient can either go to sleep or have a nerve block at the knee to make the leg numb. If the prominent bone is being removed, an incision is made, (usually on the inside) at the heel adjacent to the Achilles tendon. The prominent bone removed. If the Achilles tendon is degenerative, then the incision is often made in the midline, and the degenerative portion of the Achilles tendon is removed along with the prominent bone. A tendon is sometimes transferred to replace a portion of the Achilles tendon that cannot be repaired. The patient typically goes home the same day as the surgery.
 

What happens after surgery?

If the surgery consists just of removing the prominent bone, then the patient is kept in a splint for approximately two weeks. The sutures are removed, and the patient is allowed to begin bearing some weight after two weeks of non-weightbearing. He or she usually can bear full weight in a few days.
 
If the surgery involves repair of the tendon to any degree, then weight bearing may be delayed. A boot with a heel lift is used and physical therapy may be started at two weeks from surgery. Over the following weeks, the patient takes the lift out of the boot and then comes out of the boot altogether.
 

Potential Complications

The most significant complication with surgery in this area of the body is that sometimes the wound can be slow to heal. If the wound is slow to heal or does not heal, there may be infection requiring further surgery. This is why people at risk for wound healing problems would do better to simply avoid this surgery.
 

Frequently Asked Questions

How did I get this bony prominence in my heel?
It is unclear what causes the bone growth in this area. It can be more or less symptomatic based on what types of shoes people wear and what activities they engage in.  For some people who have swelling in that area it is not the bone growing but the Achilles or structures around it swelling.

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