Haglund’s deformity is a condition that causes pain in the back of the heel, often due to a bony bump on the calcaneus (heel bone). This deformity can lead to inflammation of the bursa (a fluid-filled sac near the tendon) and Achilles tendinosis (degeneration of the Achilles tendon), collectively known as Haglund’s syndrome or “Haglund’s triad.”
What is Haglund’s Deformity?
Haglund’s deformity occurs when a bony enlargement develops on the back of the heel, often near the insertion of the Achilles tendon. This condition is common in individuals who wear rigid shoes or engage in high-impact activities. It can cause discomfort in the heel, and sometimes, the pain may worsen with movement or certain shoes. The bony prominence can press against the bursa, causing retrocalcaneal bursitis, a painful inflammation of the bursa.
Symptoms and Diagnosis
People with Haglund’s deformity often experience pain at the back of the heel, especially when standing on tiptoes, wearing rigid shoes, or walking on hard surfaces. The skin over the heel may appear red and swollen. Doctors typically diagnose Haglund’s deformity through physical examination and imaging techniques, such as X-rays or MRI scans, to assess the extent of the deformity and any damage to the Achilles tendon or bursa.
Non-Surgical Treatment
Before considering surgery, doctors usually try conservative treatments. These may include:
Rest: Reducing activity to prevent further irritation of the heel.
Physical Therapy: Exercises to strengthen the calf muscles and stretch the Achilles tendon.
Orthotic Devices: Special shoe inserts to cushion the heel and relieve pressure.
Pain Relief: Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injections to reduce inflammation and ease pain.
These methods help many people find relief, but when the pain persists for months or significantly affects daily activities, surgery may be necessary.
Surgical Treatment Options
When conservative treatments fail, surgery is often the next step. The goal of surgery is to remove the bony prominence (calcaneal exostosis), relieve pressure on the bursa, and repair any damage to the Achilles tendon. There are different approaches to surgery, depending on the severity of the condition.
1. Open Surgery
Open surgery involves making an incision in the skin to access the heel. Through this incision, the surgeon removes the bony prominence, excises the bursa, and may repair or debride (clean up) the Achilles tendon. After surgery, the patient typically wears a cast or boot for several weeks to allow the tendon and bone to heal. Physical therapy is often recommended to restore movement and strength.
2. Endoscopic Surgery
Endoscopic surgery, a minimally invasive procedure, involves making small incisions and using a camera (arthroscope) to guide the surgeon. This method offers several advantages over open surgery, including smaller scars, less pain after the procedure, and quicker recovery times. However, it requires a high level of skill and precision.
Surgical Outcomes
Both open and endoscopic surgeries are highly effective in treating Haglund’s deformity. Most patients experience significant pain relief and functional improvement after surgery. Studies show that the majority of patients report satisfaction with their results, with many returning to their regular activities and sports within a few months. However, as with any surgery, there are risks involved, such as infections, nerve damage, or recurrence of symptoms.
Postoperative Care and Recovery
After surgery, patients need to follow specific guidelines to ensure proper healing:
Immobilization: For a few weeks, the foot is kept in a cast or brace to limit movement and protect the surgical site.
Gradual Weight-Bearing: Initially, patients are advised not to put weight on the foot. As healing progresses, they can gradually resume walking and eventually return to normal activities.
Physical Therapy: Once the cast is removed, patients work with a physical therapist to strengthen the Achilles tendon, improve flexibility, and restore normal walking patterns.
Recovery times vary, but most people can return to light activities within 6-12 weeks and resume full activities, including sports, within 3-6 months.
Conclusion
Haglund’s deformity is a painful condition that can significantly affect quality of life. When non-surgical treatments fail, surgery provides a highly effective solution. Both open and endoscopic surgeries are safe and result in excellent outcomes, with most patients reporting pain relief and improved function. If you experience persistent heel pain, it’s important to consult with an orthopedic specialist to determine the best course of action for your situation.
