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.
Do you have more questions?
Q. What is Haglund’s Deformity?
A. Haglund’s deformity is a bony enlargement that forms on the back of the heel, often at the insertion point of the Achilles tendon. It can cause inflammation of the bursa and Achilles tendinosis, leading to pain and discomfort.
Q. How is Haglund’s Deformity diagnosed?
A. Diagnosis is typically made through a physical examination, with imaging techniques such as X-rays or MRI scans used to assess the extent of the deformity and check for any damage to the Achilles tendon or bursa.
Q. What are the treatment options for Haglund’s Deformity?
A. Non-surgical treatments include rest, physical therapy, custom orthotics, and pain-relieving medications. If conservative treatments fail, surgery may be recommended to remove the bony prominence and repair the Achilles tendon.
Q. What is the difference between open and endoscopic surgery for Haglund’s Deformity?
A. Open surgery involves a larger incision to directly access the heel, while endoscopic surgery is minimally invasive, using smaller incisions and a camera to guide the procedure, resulting in quicker recovery and smaller scars.
Q. What are the benefits of surgery for Haglund’s Deformity?
A. Surgery provides pain relief, restores foot function, and corrects the deformity. Most patients experience significant improvements, with many returning to regular activities and sports within a few months.
Q. What is the recovery time after surgery for Haglund’s Deformity?
A. Recovery typically takes 6 to 12 weeks for light activities, with most patients able to resume full activities, including sports, within 3 to 6 months, depending on the type of surgery and individual healing.
Q. Are there any risks involved with surgery for Haglund’s Deformity?
A. Potential risks include infection, nerve damage, and recurrence of symptoms. However, these complications are rare, and with proper care, surgery is generally very effective in providing long-term relief.
Q. How long does it take to perform surgery for Haglund’s Deformity?
A. The procedure typically takes about 1 to 2 hours, depending on the complexity of the deformity and whether any additional procedures, like tendon repair, are needed.
Q. Will I need to wear a cast after surgery for Haglund’s Deformity?
A. Yes, most patients will need to wear a cast or a walking boot for several weeks after surgery to protect the heel and ensure proper healing of the tendon and bone.
Q. Is physical therapy necessary after surgery for Haglund’s Deformity?
A. Yes, physical therapy is usually recommended to help restore strength, flexibility, and mobility to the foot and ankle, as well as to promote proper healing and prevent stiffness.
Q. Can Haglund’s Deformity come back after surgery?
A. While recurrence is rare, it is possible for Haglund’s deformity to return if the underlying cause of the condition is not addressed or if rehabilitation is not followed properly.
Q. What are the signs that surgery for Haglund’s Deformity was successful?
A. Success is typically indicated by reduced pain, improved range of motion, and the ability to resume normal activities without discomfort. Follow-up appointments will assess healing and recovery progress.
Q. Can Haglund’s Deformity surgery be done on both feet at the same time?
A. While it is possible to perform the surgery on both feet at the same time, it is typically done one foot at a time to allow for proper healing and minimize the risk of complications.
Q. Are there any non-surgical treatments for Haglund’s Deformity?
A. Yes, non-surgical treatments include rest, ice, anti-inflammatory medications, stretching exercises, custom orthotics, and using heel lifts or padding to reduce pressure on the deformity.
Q. Is surgery for Haglund’s Deformity permanent?
A. Surgery is generally considered a permanent solution to remove the bony prominence and alleviate pain. However, patients must follow proper rehabilitation to ensure long-term results and prevent recurrence.
Dr. Mo Athar
