Haglund’s deformity is a bony enlargement on the back of the heel bone where the Achilles tendon attaches. This prominence can lead to pain and irritation, often aggravated by footwear. While non-surgical approaches are the first line of treatment, surgery is considered when conservative methods fail to provide adequate relief. This article explores Haglund’s deformity surgery and its recovery to help individuals understand if it might be a suitable option.
Non-Surgical Approaches
Before considering surgical intervention, individuals with Haglund’s deformity explore non-surgical treatments to reduce pain and inflammation. Rest and activity modification are recommended, including avoiding activities and footwear that aggravate the heel. Applying ice to the affected area helps reduce swelling and discomfort.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), manage pain and inflammation. Physical therapy incorporates stretching exercises for the Achilles tendon and calf muscles to improve flexibility and reduce tension. Strengthening exercises for the ankle muscles help stabilize the foot.
Modifying footwear is a common strategy, which may include using heel lifts, heel pads, or wearing open-back shoes to minimize pressure on the bony prominence. Custom orthotics can help redistribute pressure. Corticosteroid injections into the bursa may provide temporary relief, though direct injections into the Achilles tendon are avoided due to the risk of weakening the tendon.
Surgical Procedures
When conservative treatments do not alleviate symptoms, surgical options become a consideration. The goal of surgery is to remove the bony prominence and address any associated soft tissue damage to relieve pain and restore function. These procedures are performed as outpatient surgeries, allowing patients to go home the same day.
One common procedure is an exostectomy, which involves removing the enlarged bony bump from the calcaneus, or heel bone. This directly addresses the source of pressure on the Achilles tendon and the retrocalcaneal bursa, a fluid-filled sac that can become inflamed. The surgeon makes an incision near the Achilles tendon to access and remove the excess bone.
If the Achilles tendon has sustained damage or degeneration, the surgeon may also perform debridement or repair of the tendon. This involves cleaning out unhealthy tissue or reattaching the tendon if it has been partially detached from the bone. If a significant portion of the Achilles tendon is removed, another tendon may be transferred to augment the repair.
Minimally invasive techniques, such as endoscopic calcaneoplasty, are also available. This approach uses an endoscope and smaller incisions, leading to reduced pain, lower complication rates, and quicker recovery times compared to traditional open surgery. During an endoscopic procedure, a small burr removes the bony bump, and the bursa can be excised under direct vision without interrupting the Achilles tendon.
Recovery After Surgery
Recovery following Haglund’s deformity surgery ensures proper healing and restoration of function. Immediately after surgery, the foot is immobilized in a splint or cast. Patients are advised to elevate their leg to reduce swelling and pain, and pain medication will be prescribed.
Weight-bearing status varies depending on the extent of the surgery, especially if the Achilles tendon was repaired. If only the bone prominence was removed, partial weight-bearing in a boot with a heel lift may begin within two weeks. When tendon repair is involved, non-weight bearing may be required for a longer period, often several weeks, to protect the healing tendon.
Physical therapy is a part of recovery, starting a few weeks post-surgery. Initial exercises focus on regaining ankle range of motion, followed by strengthening exercises for the foot and ankle muscles. The physical therapist guides activity progression to ensure a safe return to normal function.
Returning to daily activities occurs gradually, with light activities resuming after several weeks. Full strenuous activities, such as sports, may take several months, ranging from six months to a year, as swelling can persist. Individual recovery timelines vary based on the specific procedure and patient adherence to rehabilitation protocols.
Making an Informed Decision
Deciding whether Haglund’s deformity surgery is appropriate involves weighing benefits against risks and individual circumstances. Surgical interventions for Haglund’s deformity have high success rates in alleviating pain and improving functional outcomes for suitable candidates. Studies indicate improvements in patient satisfaction and functional scores following both open and endoscopic procedures.
Despite favorable outcomes, surgical risks exist, as with any medical procedure. These include general risks like infection, nerve damage, or blood clots. Specific complications include persistent pain, weakness, or tightness in the heel, delayed wound healing, and in rare cases, Achilles tendon rupture.
Individual factors, such as overall health, activity level, and commitment to post-operative physical therapy, influence the success of the surgery and recovery. Patients with underlying conditions or those who smoke may experience higher risks of complications like delayed wound healing.
The decision to undergo surgery should involve a thorough discussion with an orthopedic surgeon or foot and ankle specialist. They assess the specific condition, review imaging results, and provide personalized recommendations based on symptom severity, deformity extent, and individual lifestyle and goals. This evaluation helps ensure a well-informed choice.