Haglund’s deformity is a bony enlargement on the back of the heel bone (calcaneus), often called a “pump bump” because stiff-backed shoes can cause irritation. This bony prominence rubs against the Achilles tendon and the retrocalcaneal bursa, leading to pain and inflammation. Surgery is necessary when non-surgical treatments fail to relieve the chronic pain. The primary goal of the operation is to remove the bony protrusion and inflamed tissue, relieving pressure on the Achilles tendon and bursa. Recovery is a sequential, multi-month process requiring patience and adherence to post-operative instructions.
Managing the Initial Recovery Phase
The first one to two weeks following surgery are dedicated to strict protection of the surgical site and management of pain and swelling. Immediately post-operation, the foot is immobilized in a splint or cast. The patient must remain strictly non-weight bearing (NWB), using crutches or a knee scooter to avoid putting pressure on the operated heel.
Controlling post-operative discomfort relies on a protocol of rest, ice, compression, and elevation (RICE). The leg should be elevated above the heart for most of the day to reduce swelling. Pain medication, often a combination of prescribed narcotics and over-the-counter anti-inflammatories, should be taken consistently as directed.
Wound care is fundamental to prevent infection, which is a particular concern in the heel area. The incision must be kept clean and completely dry, requiring special precautions when bathing or showering. Sutures or staples are typically removed around two weeks post-surgery during the first follow-up appointment.
Starting Physical Therapy and Weight Bearing
The transition phase, generally beginning between weeks two and six, marks a shift from passive healing to active rehabilitation. The initial splint is usually replaced with a controlled ankle motion (CAM) boot, often containing heel wedges to protect the Achilles tendon. Weight bearing gradually increases, moving from non-weight bearing (NWB) to partial weight bearing (PWB), and then to full weight bearing (FWB).
Weight Bearing Progression
The rate of weight bearing progression is highly individualized. It often involves reducing the heel wedges in the boot weekly to slowly return the ankle to a neutral position.
Physical Therapy Initiation
Physical therapy (PT) usually begins between four and six weeks post-surgery. It focuses initially on restoring gentle range of motion (ROM) in the ankle and managing residual swelling. Early exercises focus on active ankle movements, such as moving the foot up and down, to prevent stiffness. There is a strict limitation on stretching that could strain the repaired tendon.
The goals of this phase are to improve gait mechanics, restore muscle strength, and increase endurance. Patients work on regaining the ability to walk normally before transitioning out of the protective boot and into supportive regular shoes. This transition typically occurs around six to eight weeks post-operation. Progression is cautiously monitored to ensure the soft tissues, especially the Achilles tendon, are not overstressed.
Full Functional Recovery and Long-Term Outlook
The final stage of recovery extends from the third month to a full year. It focuses on returning to pre-injury activity levels and ensuring long-term stability. Low-impact activities, such as gentle cycling or swimming, can often be resumed around six weeks after surgery, followed by advanced strengthening exercises around three months. High-impact activities like running, jumping, and competitive sports require a much longer timeline.
The return to running or sport is permitted once the patient can perform specific functional tests, such as a single-leg heel raise or a single-leg hop, with adequate control and no pain. This milestone can take anywhere from six months to a year, sometimes longer for highly competitive athletes. Residual swelling, tenderness, and minor stiffness are common for many months, sometimes persisting for up to a year.
To maintain foot health long-term and prevent symptom recurrence, specific shoe wear adjustments are recommended. Patients are advised to wear supportive footwear with an appropriate heel counter and may benefit from custom orthotics. Continued calf stretching and strengthening exercises are helpful for maintaining flexibility and reducing strain on the Achilles tendon.
Recognizing Potential Post-Surgical Issues
While most recovery proceeds as planned, patients must be aware of signs that could indicate a complication requiring immediate medical attention. An infection should be suspected if there is persistent or worsening pain not relieved by medication, fever above 101.5°F, or excessive warmth and redness spreading from the incision site. Foul-smelling discharge or pus from the wound are also indicators of a possible infection.
Another potential issue is nerve irritation or damage, which might manifest as new or persistent numbness, tingling, or a burning sensation that does not improve. Sudden, severe calf pain accompanied by swelling could suggest a deep vein thrombosis (DVT), which requires emergency evaluation. Patients should not dismiss any abrupt change in their condition or sudden inability to use the foot as expected, as timely intervention is crucial for managing these complications.