A bony enlargement on the heel bone, known as Haglund’s deformity, can lead to posterior heel pain. This condition, often called a “pump bump,” typically requires surgery when non-operative treatments like physical therapy, shoe modifications, and anti-inflammatory medications fail to provide lasting relief. Patients facing surgery frequently express concerns about the pain involved in recovery. Understanding the anatomy and surgical techniques helps set realistic expectations for managing post-operative discomfort.
Understanding Haglund’s Deformity
Haglund’s deformity involves a prominent bump located on the posterosuperior aspect of the calcaneus, the heel bone. This bony protrusion is situated directly beneath the point where the Achilles tendon attaches to the bone. The condition is often exacerbated by shoes with rigid backs, which apply constant pressure against the bony prominence and surrounding soft tissues.
The irritation caused by the bony enlargement results in inflammation of the retrocalcaneal bursa, a fluid-filled sac located between the Achilles tendon and the heel bone. This inflammation, called retrocalcaneal bursitis, is a primary source of chronic pain. Continuous friction can also lead to irritation and damage of the Achilles tendon itself, known as tendinopathy. The purpose of the surgery is to remove the offending bone and inflamed tissue, eliminating the source of chronic pain.
Surgical Procedure Options
The choice of surgical technique significantly affects the recovery course, including post-operative pain and the length of rehabilitation. The two main approaches are open excision and minimally invasive techniques. Open excision involves making a larger incision along the back of the heel to gain direct access to the deformity.
Open Excision
In many cases of open surgery, the Achilles tendon must be partially or fully detached from the heel bone to allow the surgeon to remove the bony spur and damaged tendon tissue. The bone is shaved down, the bursa is removed, and the Achilles tendon is reattached to the calcaneus using specialized anchors and sutures. While highly effective for complex cases, this approach requires cautious and lengthy rehabilitation to allow the reattached tendon to heal securely.
Minimally Invasive Calcaneoplasty
The alternative is a minimally invasive or endoscopic calcaneoplasty, performed through two or three small incisions, or portals, typically on the side of the heel. This technique uses a small camera and specialized instruments to shave the bone and remove the inflamed bursa without detaching the Achilles tendon. Endoscopic procedures result in smaller scars, reduced damage to surrounding tissues, and often a quicker initial recovery because the structural integrity of the tendon insertion is preserved. However, this technique may not be suitable if there is significant calcification within the tendon that requires extensive repair.
Managing Post-Operative Pain
Patients should anticipate that the surgical site will be a source of pain once the initial anesthesia wears off. Modern pain management strategies control this acute discomfort, which is most intense in the first 48 to 72 hours following the procedure. Many patients receive a pre-operative nerve block, where a local anesthetic is injected around the nerves behind the knee, providing pain relief for approximately 8 to 12 hours after the operation.
It is important to begin taking prescribed pain medication before the nerve block completely wears off to prevent breakthrough pain. This initial regimen often includes prescription opioid pain relievers, used on a scheduled basis for the first few days, before transitioning to as-needed use. The goal is to wean off narcotic pain medication within the first one to two weeks, replacing it with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.
The RICE protocol—Rest, Ice, Compression, and Elevation—is a non-pharmacological pillar of acute pain control. Strict elevation of the operative foot above the heart, especially for the first ten days, is important to minimize swelling and reduce pressure-related pain. Diligent elevation is a direct way to manage pain and promote wound healing. Ice application to the area, typically for 20 minutes several times a day, helps to numb the site and constrict blood vessels, further reducing swelling and pain.
Recovery Timeline and Physical Therapy
The recovery timeline varies significantly depending on whether the Achilles tendon was detached and reattached during the procedure. The first phase involves immobilization and non-weight bearing for two to four weeks, requiring the use of crutches or a knee scooter. During this time, the primary focus is on wound healing and managing initial post-surgical pain and swelling.
Once initial healing is complete, patients transition to a walking boot with a heel lift, and weight-bearing is gradually introduced. Physical therapy (PT) usually begins around four to six weeks post-operation. PT sessions initially aim at restoring the ankle’s range of motion, particularly dorsiflexion, and reducing stiffness developed from immobilization.
As recovery progresses, the focus shifts to strengthening the muscles around the ankle and lower leg to normalize walking gait and improve balance. The transition out of the boot and into regular shoes often occurs between six and eight weeks post-surgery. A full return to high-impact activities like running may take between three months and one year. Discomfort during the later phases is typically manageable and stems from muscle stiffness, fatigue, or overuse as strength is regained.