A Haglund’s deformity is a bump in the back of the heel bone. The Achilles tendon runs over this bump. Patients with a Haglund’s deformity may or may not have pain.
Sometimes, people will have pain due to shoes rubbing against the bump. At other times the pain is related to degeneration in the Achilles tendon. It is not always clear how much of this Achilles tendon problem is due to the Haglund’s deformity.
If prominence is the main issue, then the goal of Haglund’s deformity surgery simply is to make the heel bone less prominent. If the Achilles tendon has degenerated as well, then the procedure may involve removing or repairing a portion of the Achilles tendon.
Patients should consider Haglund’s deformity surgery if they don’t get relief from non-surgical treatments such as medication, exercises, or changing shoes. Patients at high risk for wound issues should avoid this surgery. If the Achilles tendon is degenerative, there is a low risk of rupturing the tendon. You should discuss your options with your foot and ankle orthopedic surgeon before proceeding with surgery.
This surgery is usually an outpatient procedure, meaning you can go home the same day as your surgery. General anesthesia or a nerve block at the knee to make the leg numb will be given. If the prominent bone is being removed, the surgeon does this by making an incision at the heel next to the Achilles tendon and then removing the prominent bone. If the Achilles tendon is degenerative, then the incision often is made in the midline, and the degenerative portion of the Achilles tendon is removed along with the prominent bone. Sometimes, a tendon is transferred to replace a portion of the Achilles tendon that cannot be repaired.
If the surgery consists of removing the prominent bone only, you will be in a splint for approximately two weeks. After that your sutures will be removed and you will be allowed to begin bearing some weight.
If the surgery involves repair of the tendon to any degree, then weight bearing may be delayed. A boot with a heel lift is used and physical therapy may be started at two weeks from surgery. Over the following weeks, you will take the lift out of the boot and then come out of the boot altogether.
Risks and Complications
The most significant complication with surgery in this area of the body is that sometimes the wound can be slow to heal. If the wound is slow to heal or does not heal, there may be infection requiring further surgery.
How did I get this bony prominence in my heel?
It is unclear what causes the bone growth in this area. The severity of the symptoms depends on the types of shoes people wear and the activities they perform. Some people may experience swelling related to the Achilles tendon or structures around the bone.