Haglund's deformity, characterized by an enlarged or prominent bump at the back of the heel bone, poses a challenge as the Achilles tendon traverses over this bump, rendering it susceptible to damage from bone pressure. While some individuals with this condition may experience pain, others may not, with discomfort often stemming from friction with footwear or inflammation in the retrocalcaneal bursa, the space between the bone and the tendon. Alternatively, pain may arise from direct damage to the Achilles tendon itself.

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Cause

The exact cause of the bony prominence remains uncertain. Symptom severity is influenced by footwear choices and activity levels, with some individuals experiencing swelling related to the Achilles tendon or adjacent structures.

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Diagnosis

Distinguishing between insertional Achilles tendinitis and Haglund's deformity symptoms can be challenging due to overlapping features. However, a comprehensive history and physical examination by Dr. Kamel will help isolate the exact diagnosis. Both conditions typically manifest with pain at the back of the heel, exacerbated by pressure from certain footwear or activities that elongate the tendon. MRI scans may aid in assessing tendon damage and surgical planning.

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Treatment

Non-Surgical Treatment

Non-surgical approaches include anti-inflammatory medications, heel lifts, and transitioning to footwear that minimizes pressure on the affected area. Physical therapy is often recommended as an initial treatment, yielding positive outcomes for many patients.

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Surgical Intervention

If non-surgical measures fail to provide relief, surgical intervention may be considered. However, patients at high risk for wound complications should carefully weigh their options. Surgical goals may involve reducing the prominence of the heel bone or addressing degeneration in the Achilles tendon.

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Surgery is typically performed on an outpatient basis under general anesthesia or a nerve block to numb the leg. The procedure entails making an incision either next to the Achilles tendon or along the midline, depending on the extent of tendon involvement. Removal of the prominent bone or repair of the degenerated tendon may be performed, with occasional tendon transfer if necessary.

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Contrary to popular belief, bone spurs themselves do not cause tendon damage but rather result from tendon degeneration. Successful non-surgical treatment may not eliminate bone spurs visible on X-rays, yet alleviates pain. Should surgery become necessary, bone spur removal is typically performed as part of the procedure.

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Recovery

Post-surgery, recovery timelines vary based on the procedure performed. Patients undergoing bone removal typically wear a splint for approximately two weeks before transitioning to weight-bearing. In cases involving tendon repair, weight-bearing may be delayed, necessitating the use of a boot with a heel lift and initiation of physical therapy. Gradual removal of the lift and boot follows over subsequent weeks.

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Risks and Complications

As with any surgery, potential complications include anesthesia-related risks, infection, nerve or vessel damage, and bleeding or blood clots. Specific to Haglund's deformity surgery, residual pain, weakness, tightness, or tendon rupture may occur.