Haglund’s deformity is a bony enlargement on the back of the heel bone (calcaneus) where the Achilles tendon attaches. This prominence rubs against shoes, causing painful irritation of the soft tissues, particularly the retrocalcaneal bursa. The condition often progresses to Haglund’s syndrome, which includes the bony bump and resulting inflammation of the bursa and Achilles tendon. When conservative treatments fail, surgery becomes the primary method for structural correction. This article provides an overview of the surgical considerations and potential outcomes.
Non-Surgical Paths to Pain Relief
Before surgical intervention, conservative management is pursued to alleviate pain. Modifying footwear is a first-line approach, often involving open-back shoes or heel lifts to reduce pressure and friction against the bony prominence. Anti-inflammatory medications (NSAIDs) are used to manage the associated pain and swelling of the bursa and tendon.
Physical therapy focuses on stretching the Achilles tendon and calf muscles, reducing tension on the heel insertion site. Applying ice several times a day also helps diminish local swelling. These non-surgical measures manage symptoms but do not shrink the bony protrusion itself. Surgery is typically discussed only after these conservative methods have failed to resolve symptoms after an extended period, often ranging from six to twelve months.
Surgical Options for Deformity Correction
Surgical correction focuses on removing the source of irritation and restoring proper heel mechanics.
Simple Excision (Calcaneoplasty)
The simplest approach is a direct removal of the bony prominence, known as a simple excision or calcaneoplasty. This often includes excising the inflamed retrocalcaneal bursa. This procedure is generally suitable for deformities where the Achilles tendon is healthy and not significantly damaged.
Calcaneal Osteotomy
A more involved procedure is a calcaneal osteotomy, such as the Zadek procedure. Here, a wedge of bone is removed from the heel to change the angle of the calcaneus. This alteration rotates the heel bone, moving the bony prominence away from the Achilles tendon insertion and preventing recurrence. The choice between simple excision and osteotomy depends on the specific foot structure and the extent of the deformity.
Surgical Techniques
These procedures can be performed through traditional open techniques, which often require partial detachment and reattachment of the Achilles tendon. Alternatively, less invasive endoscopic methods use small incisions to guide specialized instruments. Minimally invasive approaches generally result in less soft tissue disruption and a quicker initial recovery. The surgeon’s choice of technique is dictated by the size of the exostosis and the structural integrity of the surrounding Achilles tendon.
Assessing the Potential Benefits and Success Rates
Surgical correction offers the permanent elimination of chronic heel pain that failed conservative care. Outcomes are generally very favorable, with success rates often reported between 85% and 95% for significant pain relief and functional improvement. The procedure provides a predictable and durable solution to this structural problem.
Successful surgery restores the ability to wear normal footwear without pain, eliminating the need for constant shoe modification. Patients frequently report a restoration of a normal, unrestricted gait and the ability to return to higher-impact activities, such as running and sports. Surgery targets the underlying bony anatomy to achieve long-term structural correction and lasting relief, unlike conservative treatments that only address inflammation.
Understanding Post-Surgical Recovery and Risks
The commitment to post-surgical recovery is a major factor in determining if the procedure is worthwhile. Following surgery, a period of non-weight bearing, typically lasting two to six weeks, is necessary to protect the surgical site and allow initial soft tissue healing. Full recovery, including the return to high-impact activities, can take anywhere from three to twelve months, depending on the procedure and whether the Achilles tendon required reattachment.
Recovery Timeline
Post-operative physical therapy is required to restore strength and flexibility to the ankle and foot. Swelling in the heel area can persist for up to six months or even a year after the operation.
Potential Risks
Specific risks include irritation or damage to the sural nerve, which runs near the incision site and can cause numbness or tingling along the side of the foot. Other potential complications include delayed wound healing, infection, and stiffness in the ankle joint. Recurrence of the deformity is also a risk, particularly if a simple excision was performed without adequately addressing the underlying foot structure. The lengthy recovery process and potential complications must be weighed against the expected long-term pain relief and functional gains.