Haglund Deformity Surgery
What is a Haglund`s deformity?
A Haglund`s deformity, also known as “pump bump” or Bauer bump, is a condition where a bony enlargement formson the back of the heel bone.It is sometimes called “pump bump” as the condition often develops because of the pump-style high heels that many women wear. The rigid backs of the shoes create pressure that irritates the back of the heel, and people who wear shoes that are too tight or stiff in the heel are the most common sufferers of this condition.You may also be more at risk for developingHaglund`s deformity if you have a high foot arch, a tight Achilles tendon, or tend to walk on the outside of your heel.
The Achilles tendon runs over the bump, so patients with a Haglund`s deformity typicallyexperience pain. The first symptoms begin with the enlargement of the bone at the back of the heel where the Achilles tendon attaches. As a rule, the bump is painful, especially when a person wears tight shoes that create rubbing friction on the heel. It becomes swollen or red, and may form a bursa. Bursitis is an inflammation of the fluid-filled sac between the tendon and the bone. When the heel becomes inflamed, calcium can build up in the heel bone. This makes the bump larger and increases your pain.At other times, pain can be caused by degeneration in the Achilles tendon due to the pressure placed there.It is unclear what causes the bone growth in this area, and for some people who have swelling in the heel area, it is not actuallythe bone growing but the Achilles or structures around it swelling.
Haglund`s deformity can be difficult to diagnose, because the symptoms are similar to those associated with other foot issues, including Achilles tendonitis.
Your doctor may be able to diagnose the condition based on the appearance of your heel. Your doctor may also request an X-ray of your heel bone if they are concerned that you have Haglund`s deformity.
An X-ray may also help your doctor create orthotics to relieve your heel pain. Orthotics are customized shoe inserts made to stabilize your foot.
Treatments for Haglund`s deformity usually focus on relieving pain and taking the pressure off your heel bone. Nonsurgical options include:
- taking non-steroidal anti-inflammatory drugs (NSAIDs), such as Tylenol or Advil
- wearing open-backed shoes, like clogs
- icing the bump for 20 to 40 minutes per day to reduce swelling
- getting a soft tissue massage or ultrasound treatments
- wearing orthotics or heel pads to reduce pressure from your shoes
- wearing an immobilizing boot or cast
Surgery can also be used to treat Haglund`s deformity if less invasive methods don’t work. During surgery, your doctor will remove the excess bone from your heel. The bone may also be smoothed and filed down. This reduces the pressure on the bursa and soft tissue.
Goals of Surgery for a Haglund`s Deformity
- With most cases, the prominence of the bump is the main issue, so the goal of surgery is simply to make the heel bone less prominent to relieve pressure and pain against it.
- If there is also Achilles tendon degeneration present, then surgery may involve repairing the Achilles tendon as well.
Pain that is doesn’t respond to non-surgical treatment is the main indicatorsomeone should consider a surgical correction. If the Achilles tendon is degenerative, there can also be the risk of rupturing the tendon, although that risk is low.
General Surgery Details
A patient is prepared for Haglund`s deformity correction with either general anesthesia or a local nerve block administered behind the knee. If the prominent bone is being removed, an incision is made, usually on the inside of the heel, adjacent to the Achilles tendon. The protruding section of the heel bone is then removed. If the Achilles tendon is degenerative, then the incision is often made higher in the calf, and the damagedsection of the Achilles tendon is repaired, along with the removal of the protruding bone. A tendon is sometimes transferred to replace a portion of the Achilles tendon that cannot be repaired. The surgeryis typically performed on an outpatient basis, so the patient can go home the same day.
If the surgery consists only of removing the prominent bone, then the patient is kept in a cast or splint for approximately two weeks, and should not bear any weight on the affected leg. The sutures are removed, and the patient is allowed to begin bearing some weight.A person canusually bear full weight within a few days after the removal of a cast/splint.
If the surgery involves repair of the Achilles tendon, then weight bearing may be delayed. A boot with a heel lift is used and physical therapy may be started two weeks after surgery. Over the following weeks, the patient takes the lift out of the boot and then comes out of the boot altogether.