What is a Haglund's Deformity?

A Haglund's deformity is a bump in the 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, the pain is caused by shoes rubbing against the bump. 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.

If prominence is the main issue, then the goal of Haglund's deformity surgery simply is to make the heel bone less prominent. If the Achilles tendon has degenerated as well, then the procedure may involve the Achilles tendon directly.

Diagnosis

If patients don't get relief from non-surgical treatment, they should consider surgery. Patients at high risk for wound issues should strongly consider avoiding surgery. If the Achilles tendon is degenerative, there is a low risk of rupturing the tendon. You should discuss your options with your foot and ankle orthopaedic surgeon before proceeding with surgery.

Treatment

This surgery is usually an outpatient procedure, meaning the patient can go home the same day as surgery. General anesthesia or a nerve block at the knee to make the leg numb will be given. If the prominent bone is being removed, an incision is made at the heel next to the Achilles tendon and the prominent bone removed. If the Achilles tendon is degenerative, then the incision often is made in the midline, and the degenerative portion of the Achilles tendon is removed along with the prominent bone. Sometimes, a tendon is transferred to replace a portion of the Achilles tendon that cannot be repaired.

Recovery

If the surgery consists just of removing the prominent bone, 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.

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.

Risks and 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. 

FAQs

How did I get this bony prominence in my heel?
It is unclear what causes the bone growth in this area. The severity of the symptoms depend on what types of shoes people wear and activities they perform. 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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