What is a Haglund deformity?
Haglund deformity also known as 'pump bump' is a bony enlargement on the back of the heel which can cause mechanical irritation (see images below). As it is formed at the insertion of the Achilles tendon, the soft tissue near the tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis (inflammation of the bursa). Patients will either complain of pain and difficulty with foot wear because of the size of the prominence or pain deep to the Achilles tendon because of inflammation (Haglund syndrome).
Clinical and radiographic appearance of Haglund deformity
What are the indications for surgery?
In the majority of patients, non-surgical treatment remains effective with the use of non-steroidal anti-inflammatory medication, heel lifts, padding and shoes that do not exert pressure over this area. However, if bursitis (inflammation of bursa) is the main pain generator, a one off cortisone injection into the bursa could be considered. Surgical treatment is indicated if there is failure of several months of nonsurgical treatment. Several different approaches and techniques, including endoscopy, are available.
How is the operation done?
You will be admitted on the day of operation. The operation takes about 45 min to 1 hour and is routinely done under a general anaesthetic. Occasionally a spinal anaesthetic may be considered. Most patients go home the same day.
The removal of the Haglund's deformity and bursa can be done endoscopically (‘keyhole’ operation) or open, depending on the extent of involvement. In the ‘keyhole’ operation, 2 keyhole incisions are made on either side of the tendon and the bone and bursa are removed using ‘keyhole’ instruments. In the open technique, a small incision (4 – 5 cm) is made on one side of the tendon to allow surgical access for the procedure. Following surgery, a bandage and boot is applied to protect the ankle for 2 - 3 weeks. Most patients would be able to weight-bear immediately following surgery.
Endoscopic image of retrocalcaneal bursitis
Endoscopic image after removal of bursa and Haglund
Aftercare and FAQs
It is important to keep the leg elevated as much as possible especially for the first 2 weeks. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours. Your first clinic follow-up is usually 12 to 14 days after surgery.
Wound care – The dressing should be kept dry. At yours fist clinic appointment, wound inspection and suture removal will be undertaken.
Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If your job is physical, you may need to stay off work until the boot / cast is removed.
Driving - You will not be able to drive for 2 to 3 weeks following surgery (depending on the type of operation). However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 weeks following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
What are the surgical risks?
Nerve damage – causing numbness and painful scar
Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the vein or lungs – to reduce this risk you may be prescribed heparin injections if you are not weight-bearing (unless contraindicated)
Prolonged swelling and stiffness
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.