By Bryanna D. Vesely, DPM, MPH
Haglund’s deformity refers to a condition when there’s a bone spur on the calcaneus (or heel bone) where the Achilles tendon attaches. This can cause pain and inflammation in your Achilles tendon as well as retrocalcaneal bursitis. The condition typically impacts middle-aged females but can affect anyone.
Although the cause is unknown, genetics can play a significant role as this condition often runs in families. It can also be caused by overuse of the Achilles tendon in activities such as running, wearing tight shoes, and having a tight Achilles tendon.
People have nick-named Haglund’s deformity a “pump bump” as it presents as a large bump in the back of their heel and can be aggravated when wearing shoes with a tight back, like pumps. Symptoms include a noticeable bump on the heel, discoloration of the skin around the bump, pain, and swelling where the Achilles inserts. Patients with mild symptoms often self-diagnose this condition as plantar fasciitis when they Google “heel pain” and never seek treatment nor get a formal diagnosis of Haglund’s.
When diagnosing patients, I always order X-rays to rule out other osseous causes of heel pain, such as a stress fracture or acute fracture, calcaneal cyst, subtalar joint arthritis, and more. The bony growth on the posterior superior aspect of the heel is the signature identifier of Haglund’s deformity.
Management of Haglund’s is handled conservatively whenever possible with NSAIDs, icing, orthotics, open-back shoes, heel lifts, and physical therapy. Patients can learn to live with and manage symptoms, but having Haglund’s deformity is a lifelong condition.
Recalcitrant cases that cause severe pain and dysfunction are surgically treated; however, recovery has been historically challenging due to the open nature of the traditional repair surgery, needing to de-attach the Achilles to resect the bone spur, and the long incision, which tends to dehisce easily. Because of the high rate of wound healing complications, patients are often kept non-weight-bearing for four to six weeks. They love wearing a splint and using crutches or a knee scooter for weeks waiting for that persnickety incision to heal!
That’s why I’mt so excited about the new Arthrex Minimally Invasive FiberTak Achilles Speedbridge System® that has revolutionized Haglund’s Repair Surgery. I’ll describe why:
- Instead of a four to five-inch incision, I access the Achilles tendon and calcaneus through four tiny incisions, using minimally invasive endoscopic techniques. Good riddance, wound dehiscence!
- The Achilles anchoring system has knotless rip stop sutures as well as the 4-anchor knotless configuration which provides excellent tendon fixation.
- Because of the strength of the anchor system and smaller incisions, I allow patients to bear weight early after surgery.
- Patients recover more quickly, with less pain, and are happier due to much less time spent non-weight bearing. Happier patients are more compliant and participate more fully in physical therapy.
I’ve performed the first of these new Haglund Repair Procedures on the Peninsula and have more than three scheduled for my thrilled patients.
Bryanna Vesely, DPM MPH is a fellowship-trained podiatric surgeon who will be joining Orthopaedic & Spine Center on Sept. 2, 2024. She completed a high-level of training to specialize in the most up-to-date technology and cutting-edge surgical interventions including minimally invasive surgery, sports medicine injuries, and advanced reconstruction. osc-ortho.com
