Haglund’s Correction with Removal of Retrocalcaneal Spur and Transverse Achilles Tenoplasty : 2 Case Reports «

Haglund’s Correction with Removal of Retrocalcaneal Spur and Transverse Achilles Tenoplasty : 2 Case Reports

with 104 comments

by Al Kline DPM¹

Podiatry Internet Journal 2 (1):1

Abstract

Two case presentations are described using a transverse incision technique for Achilles tendon repair. This approach differs from the vertical incisional approach of tendon repair that is most often described in the literature. These two cases represent the most severe type of retrocalcaneal exostosis. The transverse incisional approach allows adequate exposure and removal of bone. Both cases utilize soft tissue anchor sutures to plicate the tendon directly to raw bone with secure and strong fixation of the tendon attachment. An in-depth discussion is outlined discussing the anatomy of the posterior calcaneus and the Achilles tendon attachment into the posterior calcaneal tubercle. The vertical and transverse tenoplasty are compared and discussed. A literary review of Achilles attachment supporting this technique is introduced. Mid-line, vertical incisions continue to have their place in tendon pathology that may require removal of mid-tendon pathology. However, in the absence of such pathology, this technique is an alternative to mid-line transection of the tendon.

Introduction

Patrick Haglund was the first to describe a deformity associated with pain to the back of the heel in 1928. He identified pain associated with bony prominence to the posterior superiolateral aspect of the calcaneus. [1] A Haglund’s deformity or ‘pump bump’ is described as a ridge of bone along the posterior superior lateral ridge of the calcaneus. Irritation and bone prominent in this area will often cause bursal inflammation of the Achilles bursa and lead to a painful swelling and discomfort to the back of the heel. Many times there is an associated calcification or spur of the posterior portion of the calcaneus. This may take form at the Achilles insertion and commonly involves calcification within the tendon itself.

There are a number of conditions that can cause insertional tendonitis. Seronegative spondarthritides such as ankylosing spondylitis (AS), Reiter’s syndrome (RS), psoriatic arthritis (PsA) and intestinal arthropathies and Behcet’s syndrome have been linked to insertional Achilles tendonitis. [2] Other conditions that have been described include rheumatoid-like nodules presenting as Haglund’s deformity in a female. [3] Differences in actual bursitis, paratendonitis and actual Achilles tendon pathology is sometimes difficult to differentiate. Pain may result from actual paratenon inflammation, partial Achilles tendon tears and previous injury to the tendon that lends itself to Achilles fibrosis and nodules in the tendon itself. In the absence of such conditions, Achilles tendonitis, Achilles bursitis and retrocalcaneal bone pain is most commonly associated with either bone hypertrophy to the lateral ridge of the calaneaus and/or large posterior retrocalcaneal bone spurs. Conservative care including rest, heel lifts, NSAIDS, immobilization and even steroid injections into the bursa just anterior to the tendonous attachment is useful in alleviating the pain associated with painful Achilles bursitis. However, when conservative measures fail or cease to improve the symptoms, surgery to decompress the bursa and remove calcification to the posterior heel is indicated. It is important to diagnose the condition properly, especially if surgery is considered. Simple bumpectomies and removing the superiolateral ridge of the posterior calcaneus can alleviate symptoms without violating the Achilles tendon. There have been a number of techniques described over the years for the correction of both Haglund’s heel and posterior calcaneal spurring. Surgical descriptions in the literature addresses either posterior lateral ridge decompression of the calcaneus, postserior spur removal and/or Achilles calcinosis excision.

Anatomy

A thorough understanding of the anatomy of the posterior heel is needed to appreciate the complexity of symptoms and surgical approaches required to correct this condition. If one looks at an anatomical specimen of the posterior heel, there is a central ridge that corresponds with most of the Achilles insertional attachment. In an in-vitro anatomical study of 17 adult fresh-frozen below-knee cadaver amputations, it was found that all specimens revealed tendon termination at the medial and lateral borders of the calcaneus without extension around its borders. There was also a greater attachment and distance of insertion on the medial aspect of the calcaneus. [4] Before its attachment, the tendon actually lacks a true synovial sheath, unlike other smaller tendons in the foot and is rather enveloped with dense paratenon.

In the figure at left , (1) corresponds to the superior ridge of the calcaneus. (red) Hypertrophy of bone to this ridge along its superior lateral border is considered the classic Haglund’s deformity. This area is devoid of Achilles attachment. No fibers of the Achilles tendon attaches in this area. As the Achilles tendon traverses along the posterior heel, (2) the Achilles bursa (green) sits directly in front of the Achilles tendon along the superior half of the posterior calcaneus. (3) There is a bone ridge corresponding to the posterior calcaneal tuberosity where the majority of the Achilles tendon is attached. (blue) The tuberosity is located more central along the posterior calcaneus. Reports of calcaneal avulsion fractures in this area is testament to the strong attachment of the Achilles tendon in this region. [5,6]

Radiographic Evaluation

The radiographic evaluation of the Haglund’s heel is very well described in a free, online article in the July 1982 issue of theRadiology Society of North American online journal. This is a good article which describes the historical references of radiographic angles. It includes a good description of the use of parallel pitch lines (PPL) and Fowler & Philip angle in the radiographic evaluation of the Haglund’s heel.

Literary Review

In 1991, Marcia et al described a new surgical approach in addressing the calcified tendon Achilles insertion and retrocalcaneal exostosis. A medial to lateral crescentic osteotomy is performed in order to preserve the attachment of the Achilles tendon at the calcaneal tuberosity. The procedure describes reattaching the tendon and bone into a newly formed gap with bone chips and fixated with a single cancellous screw. [7] Newer procedures have attempted to preserve that Achilles attachment and eliminate bone prominence by endoscopic technique. [8,9] In 1965, Keck and Kelly described a posterior wedge osteotomy in an attempt to decrease the angle described by A. Fowler and J.F. Philip in 1945. [10,11] In 1992, Michael Perlman, DPM described a case report of a 19 year old female who underwent the Keck & Kelly osteotomy using a staple device. [12] However, the majority of the procedures performed today involves removing the Haglund’s bone and reattaching the Achilles tendon after resecting bone along the posterior calcaneus to decompress the back of the heel. In the mid to late 1980’s, the Mitek® anchoring system was introduced that dramatically improved our ability to reattach tendons and ligaments in repair of the foot and ankle. [13]. This system was primarily used in repair of rotator cuff injuries and gained popularity as a fixation device for foot and ankle surgery in the early 1990’s. In a 2004 study of 21 patients with recalcitrant posterior heel pain, there is a reported 62-88% improvement in symptoms utilizing a soft tissue anchor system and posterior partial calcanectomy with Achilles tenoplasty to improve insertional Achilles tendinopathy. [14] Various approaches to surgical reconstruction of the Achilles tendon has been described. In 1995, Amol Saxena, DPM described various incisional approaches to decompression of the Achilles tendon. [15] Three varying procedures were described including tenolysis of the peritenon, surgical management of tendonosis and a modified lazy-S approach to Tendocalcinosis and Achilles tenodesis or tenoplasty. 21 procedures in 19 patients were reported. His report is particularly interesting because most of the patients were highly athletic, including three sub-four minute milers and one eight-time national cross country champion. All patients returned to daily activity without pain. The tenodesis group returned to their desired activity 14 weeks postoperatively. It was also noted that use of the Mitek® soft tissue anchors decreased the morbidity associated with previously described procedures that required Achilles disruption in order to remove bone from the posterior calcaneal tubercle. Surprisingly, there have been very little reports of complication or failure of these soft tissue anchors. However, I have physically been able to pull out the two-prong Mitek® soft tissue anchor that has prompted the company to go to a four-prong design in recent years.

Vertical versus Transverse Tenoplasty

Incision approach to retrocalcaneal exostosis has also been debated as to its best approach. Vertical incisions versus transverse detachment of the tendon have been described. In 1997, a new method for reattachment of the tendoachilles was described establishing relative attachment strength comparing the Krackow suture technique to a vertical mattress technique in 6 cadaver specimens. [16] A modified running and interlocking stitch was introduced in order to close a mid-line, vertical incision. However, there is little report in the literature at this writing concerning the best approach. Is vertical incision of the tendon that requires tendon, midline repair the best approach? Or is a transverse incision across the Achilles tendon fibers at its attachment that does not require mid-line repair the best approach? When removing retrocalcaneal spurs, the fibers get very thin and sparse past its attachment and some fibers appear to insert past the tubercle. It must be said that the majority, if not all of the Achilles attachment is on the posterior calcaneal tubercle. It appears there is adequate exposure of the tendon from a lateral approach, detaching the tendon and then remodeling the tubercle as well as resecting a portion of the superiolateral border of the calcaneus. The results would be similar for a central vertical incision of the tendon, but it appears that cutting of the tendon vertically and superior to its attachment may be unnecessary when tendon pathology is absent. Itis necessary in a vertical incision in order to gain exposure to the superior ridge of the posterior calcaneus. However, in the transverse approach, the tendon can be reflect as a whole while resecting the Haglunds heel. The only foreseen drawback to the transverse approach is the apparent inability to remove intracalcinosis or degeneration within the tendon superior to its attachment. However, anterior removal of calcinosis and degenerative mucoid cysts can be accomplished without having to split the tendon through the vertical approach. It is the authors preference to transect the tendon horizontally or transversally along the superior ridge of the posterior calcaneal tubercle, resect the superior lateral ridge and reattach the tendon using soft tissue anchors. This approach is supported by the in-vitro studies revealing greater Achilles attachment and distance of insertion on the medial aspect of the calcaneus. [4] The lateral approach will allow greater exposure of the Haglund’s heel. Also, when the transverse incision is used to resect the posterior calcaneal tubercle, a portion of the tendon still has its attachment along the medial aspect of the calcaneus.

Surgical Technique

A. Vertical Incisional Tenoplasty

The vertically placed incision begins with a lazy s type incision (1.) starting superior laterally and extending across the heel inferior medial. As the incision is deepened through a small layer of subcutaneous fat, the paratenon is identified and the thick Achilles tendon fibers are visualized. Using sharp dissection, a centrally placed vertical incision is taken directly down to bone. The tendonis is then reflected medially and laterally (2.) in order to identify the posterior Haglund’s ridge for resection. Any Achilles calcinosis within the tendon can also be removed if identified. At its attachment, the fibers of the achilles tendon is reflected from the calcaneal tubercle.

Once adequate bone is removed, two or three Mitek® soft tissue anchors (3.) are tapped into the bone at the region of the calcaneal tubercle. The repair is made by a modified Bunnel’s type suture technique (4.) commonly used in tendon repairs.

B. Transverse Incisional Tenoplasty

This approach utilizes a lateral J-type incision (1.) along the posterior lateral ridge of the calcaneus. Once the incision is deepened to the border of the tendon, the tendon can then be reflected by blunt and sharp dissection off the medial posterior calcaneal border at its attachment. The tendon is then sharply dissected from lateral to medial in order to expose the large retrocalcaneal bone spur. (2.)

Once adequate bone is removed and the posterior heel is remodeled, three Mitek® soft tissue anchors (3.) are tapped into the bone at the region of the calcaneal tubercle. Since there is no vertical incision, no longitudinal tendon repair is required. Anchor sutures are directed from the anterior tendon posteriorly and back through ensuring the bury and tie the suture knot into the bone. The foot is plantarflexed in order to take tension off the tendon. Suture placement is driven as such to direct the force of pull toward the inferior direction of tendon pull (arrows). This provides a very secure anchor site as the tendon is pulled against raw bone.

Case Presentations

Two cases are presented including a female (patient 1) and male (patient 2) with very large retrocalcaneal spurs and chronic posterior heel pain for over a two year duration. Both patients responded to conservative injection therapy and other conservative measures early in treatment. However, both of their condition deteriorated to the point both had constant pain and had difficulty wearing closed shoes. Patient 1 underwent transverse incisional tenoplasty with retrocalcaneal resection using Mitek® soft anchors and Patient 2 underwent the same technique with the use of 3.5mm Arthrex® soft tissue anchors.

Description of Procedures

Case # 1

A 50 year old female who is active and enjoys walking presents to our office with increased posterior heel pain. She underwent about 6 months of conservative care including padding, heel lifts, local bursal injection therapy, physical stretching therapy and antiinflammtory treatment. Her condition progressed to require surgical intervention.

Her radiographs reveal a classic retrocalcaneal spur or exostosis with local soft tissue inflammation and bone changes noted to the superior lateral border of the calcaneus. The following sequence of photos represents the surgical correction of her deformity using the Mitek® soft anchors.

The initial surgical approach involves a j-shaped incision along the lateral border of the calcaneal ridge. (since this is the right foot, it is a reverse-J) This is deepened down to the lateral border of the tendon. With careful soft tissue dissection, the entire lateral border of the Achilles tendon can be reflected exposing the calcaneus underneath. Note how there is very little attachment of the tendon along this ridge. A portion of the Achilles attachment is transected to allow for better visualization of the posterior calcaneal tuberosity. Also note the Achilles bursa as it is situated along the anterior surface of the Achilles tendon as it is reflected.

Once, there is adequate exposure, the calcaneal tubercle as well as the superior lateral ridge of the calcaneus is removed in one piece. Here, a measuring device records the amount of bone resected. About 3 cm of bone is removed.

The plication of the tendon to raw bone is accomplished and secured using three Mitek® soft tissue anchors. The suture anchors are first tapped into the bone, one along the superior portion of the calcaneus and two others along the region of the calcaneal tubercle. The suture is then drawn up through the tendon and back through and tied to the second strand of suture. This is repeated for all three suture anchors. The foot is slightly plantarflexed and the sutures are secured tightly.

Once the sutures are in place, a 3-0 suture is used to approximate the paratenon and more superficial subcutaneous layers. The skin is then closed with a simple horizontal mattress suture. As you can see from the photos, the entire posterior heel is decompressed.

In the postoperative radiographs, this sequence illustrates postoperative changes after surgery. The photo sequence represents 1 year, 2 years and 4 years after surgery. It is interesting to note the changes that will occur after surgery. Some stress on the Achilles tendon can lead to some recurrent spur formation. However, this patient has remained asymptomatic. You can see by year 4, there is extensive remodeling of the postserior calcaneus with some reactive changes to the bone along the Achilles attachment.

Because of the recurrent bone formation, some may argue that such an aggressive resection to the posterior heel is not warranted. However, in order to achieve an adequate decompression with large retrocalcaneal spurring, removal of the spur is necessary. Also, cosmetically and clinically, the patient is very pleased with the visual results and there is no associated pain or discomfort. The patient has also commented that she is now able to wear a closed heel without discomfort.

Case #2

A 60 year old male presents to our office with large, posterior calcaneal Haglund’s deformities in 2003. He has had multiple heel spur surgeries in the 1970’s and 1980’s. The patient is active and has tried putting off surgery as long as possible. He underwent conservative care including padding, heel lift and NSAID therapy. He presented to us again in 2004 and was actually scheduled for left Haglund’s surgery. His right heel is less symptomatic. Again, he postponed surgery due to work and presents to us in 2006 with increased pain and discomfort. His pain was getting so severe, he described a ‘throbbing’ and ’stabbing’ type pain to the back of the left heel. He was taking Darvocet and Alleve for pain. He was scheduled for surgery in November 2006.

His clinical presentation is very impressive. The posterior enlargement is made even more dramatic by the swelling of the Achilles bursa. On the preoperative radiograph, there is a large ‘hook’ spur noted to the posterior calcaneal tubercle. Also, the posterior superior ridge has bony calcification and reactive periostitis with increased soft tissue density and swelling to the Achilles bursal sac.

Again, a J-shaped incision is made along the lateral border of the posterior heel. It should also be pointed out that the Sural nerve is more lateral to this incision.

In the first photo, the incision is deepened down along the lateral border of the Achilles Tendon. It is interesting to note the thickened tendon and the bursal fluid that was decompressed after incision. About 2 to 3 cc’s of bursal fluid was drained through this incision. The transverse incision is then performed detaching the lateral portion of the Achilles tendon from the posterior calcaneal tubercle. The photos demonstrate the impressive posterior retrocalcaneal spur that is visualized at the Achilles attachment. The last photo in this sequence illustrates the amount of Achilles attachment at the actual tubercle with very little fiber attachment past the tubercle.

The large retrocalcaneal spur is then removed with a bone saw or osteotome. The second photo represents the removal of the more superior ridge of the calcaneus or Haglund’s bone. Once the posterior calcaneus is remodeled smooth, 3.5mm Arthrex® soft tissue anchors x 3 are placed along the resected region of the posterior calcaneal tubercle. Although there is little Achilles attachment past the tubercle, it is important to fashion a soft tissue flap. This flap will form a small buttress along the transverse incision when closing.

Once the 3 soft tissue anchors are in place, the Achilles tendon is pulled down flush against the bone and tied. The single most superior anchor is tied first, then the medial and lateral anchors are hand tied. It is important to visualize the point of Achilles attachment to the region of the tubercle and suture the tendon directly to this area. Placing and attaching the tendon more superior or proximal to this area will cause tendon shortening. Certainly, if the tendon requires lengthening, this can be easily accomplished proximally or even percutaneously.

This is a good view of the inferior tissue flap that helps to buttress the Achilles closure. Here a monofilament suture is used to buttress the inferior Achilles attachment and the subcutaneous layer is then closed.

The incision is then closed. The fragments of bone (inset) represents the amount of bone removed from the posterior calcaneus. The radiographs shows the placement of the cork-screw, 3.5mm Arthrex® soft tissue anchors. Postoperative course includes complete nonweightbearing for 6 weeks. The patient will remain initially in a posterior splint until the sutures are removed in about 2 weeks. The patient will then progress to a short leg cast (SLC) for an additional 4 weeks. Once out of the cast, the patient will begin physical therapy and stretching exercises with slow progression back to weight bearing.

Comment and Conclusions

There appear to be some inherent advantages to the transverse approach described. Firstly, the skin incision is made much more lateral than a traditional mid-line incision. To date, I have not witnessed any difficulty healing or coapting of this incision versus a mid-line placed incision. Also, if scarring occurs at the skin level, this may be more irritating if the incision is placed directly mid-line. Secondly, reflection of the tendon is made easier along this lateral approach. Careful anatomical studies have described specimens revealing tendon termination at the medial and lateral borders of the calcaneus without extension around its borders. There was also a greater attachment and distance of insertion on the medial aspect of the calcaneus. [4] The transverse approach allows resection of the posterior calcaneal tubercle without disturbing the medial region of attachment. Thirdly, there is no need for a central splitting of the achilles tendon. A number of plication techniques have been described as an Achilles soft tissue anchor from Mitek®and Arthrex®to TiMax®spider plates [17]. Mitek®and Arthrex® soft tissue anchors provide strong bone to tendon interface approximation. It is the authors preference to use the Arthrex® cork-screw type soft tissue anchor to prevent risk of pull-out. The technique is not technically difficult and hemostasis is adequately achieved without the use of bone wax or other hemostatic agents. As described in case #1, there can be recurrent spurring along the attachment as seen after 4 years. However, there does not appear to be any long term complications with this technique.

References

1. P. Haglund Beitrag zur Kinik der Achillesscehne. Aschr-Orthop Chir 49:49, 1928.

2. Gerster, J.C. Plantar Fasciitis and Achilles Tendinitis Among 150 Cases of Seronegative Spondarthritis. Rheumatology and Rehabilitation, 19: 218-222, 1980.

3. Siciliano, C.J., Mozen, N.A. Rheumatoid-like Nodules Presenting as Haglund’s Deformity in an Adult, Nonarthritic Patient JFAS, 32 (5): 484-489, 1993.

4. Chao, W. et al Achilles tendon insertion: an in vitro anatomic study Foot Ankle Int. 18(2): 81-84, Feb. 1997.

5. Biehl, WC, et al Neuropathic calcaneal tuberosity avulsion fractures. Clin Orthop Relat Res. (296):8-13, November, 1993.

6. Itokazu M., et al A neglected avulsion fracture of the calcaneal tuberostiry associated with diabetes mellitus: a case report. Changgeng Yi Xue Za Zhi. 19(3): 277-280, September , 1996.

7. Marczak, L. et al Calcified Tendo Achilles Insertion: A New Surgical Approach JFS 30 (5): 457-459, 1991.

8. Niek van Kijk, C. et al Endoscopic Calcaneoplasty. The Am J of Sports Med 29:185-189, 2001.

9. Leitze, Z. et al Endoscopic Decompression of the Retrocalcaneal Space JBJS, 85:1488-1496, 2003.

10. Keck, S.W., Kelly, J.P. Bursitis of the posterior part of the heel. JBJS , 47A:267, 1965.

11. Fowler, A. , Philip, J.F. Abnormality of the calcaneus as a cuase of painful heel: its diagnosis and operative treatment. Br. J. Surg. 52:494, 1945.

12. Perlman, M. D. Enlargement of the Entire Posterior Aspect of the Calcaneus: Treatment with the Keck and Kelly Calcaneal Osteotomy JFS 31 (5), 424-433, 1992.

13. Pederson, B. Tesoro, D. Mitek Anchor System: A New Technique for Tenodesis and Ligamentous Repair of the Foot and Ankle JFS 30 (1): 48-50, 1991.

14. Maffulli, N. et al Calcific Insertional Achilles tendinopathy: reattachment with bone anchors. Am J Sports Med. 32 (1): 174-182, Jan-Feb 2004.

15. Saxena, A. Surgery for Chronic Achilles Tendon Problems JFAS 34 (3), 294-300, May/June 1995.

16. Weinraub, G.M. et al A New Method for Reattachement of the Tendo Achillis Following Retrocalcaneal Exostectomy. JFAS 37(2), March/April 1998.

17. Yu, G., et al Enhanced Tenodesis for Retrocalcaneal Surgery. JAPMA 92 (4), April 2002.

¹Dr. Kline is in private practice in Corpus Christi, Texas. He can be reached by email at al@kline.net.

© Podiatry Internet Journal , 2007

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Written by Moderator

January 1, 2007 at 1:00 am

Posted in Achilles Tendon, Achilles bursitis, Benign Neoplasm, Bone Spurs, Haglund Deformity

104 Responses

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What an interesting article. I had searched the net for weeks before I came across this. My heel problem is just this. It is mild so far. I have rested it and it is better but not curered. Can the problem correct itself? My bumps have definately gone down, and are presently not nearly so painful, just a hint of mild soreness. Could it disappear in time?
Hope you can help. Thanks, Harriet

Harriet Troy

March 15, 2007 at 3:14 am

Reply
What was the recovery time for both cases? What is the generally expected recovery time?
Thanks, Sharon

Sharon Fortner

July 20, 2007 at 12:17 pm

Reply
My daughter appears to have this condition and it has recently become very painful for her, we will be taking her to a Doctor to look into treatment, but we’re curious about the surgery recover time? She is a high school senior and college bound soccer player, so non-surgical treatment and surgery recovery time are her two biggest questions.

Tom Ross

September 3, 2007 at 8:23 pm

Reply
It depends on what type of Haglunds resection she will undergo: i.e. a simple bumpectomy vs. achilles tenoplasty with removal of bone spurring. In my opinion, a decompression of the bursa by removing a portion of the calcaneus (and plicating the tendon) gives the best results. In sedentary and older individuals, full recovery can take up to a year after surgery. In younger athletes, recovery can vary. You must remember, after surgery, there is a period of immobilization in a cast for about 6 weeks and physical therapy to strengthen the Achilles tendon for another 4-6 weeks after casting.

If your daughter is an athlete and college bound, I would not attempt surgery unless the condition is crippling and interfers with her soccer. Otherwise, shoe modification, anti-inflammatory treatment and padding is your best conservative option. Also, stretching and local therapy can be helpful.

PICOMM/PIJ Editors

September 4, 2007 at 3:07 pm

Reply
I am on week 6 of non-weightbearing after having the bump removed. The bursa in my afflicted heel was also removed as it was starting to crystalize. My achillies was anchored down by 4 anchors & an incision was made on the back of my calf to help lengthen my achillies which was very tight.
Now on to partial weight bearing starting next week-I hope. I’m a ski instructor at a major resort in Colorado & was told I could possibly ski by Feb. 08. Was my surgeon kidding or can this be a reality with hard work?

Sarah McCourt

November 1, 2007 at 10:51 am

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What are the chances of having pump bump on both heels?
i have had a progression of pain building up on both heels over a period of 1 year, November last year it was so bad that the iinflamation/calcaneus was enlarged by at least 30%. So painfull in both heels that i could only manage a shuffle. Anti inflamatories
lots of rest and cortisone injections made little difference.
My question is can both heels be opperated on at the same time? Will i be bed bound?
Must i only do one at a time?
Is the recovery of Haglund’s surgery more painfull than the symptoms?

mario

January 21, 2008 at 1:55 am

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I had surgery Nov 6, 2007 for pump bump on my right heel. Surgery went ok and I wore a cast for 3 wks, then a walking boot. It has now been over 2 months and I have such pain on the lower right side of my heel. I cannot walk without limping and the pain comes like a stab when I am just relaxing. I am on anti-inflammatory for what dr. says is an inflamed achilles tendon, but this is awful. Will the pain finally go away or does this sound like another problem for me? Linda

linda

January 23, 2008 at 3:15 pm

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I have had heel pain for 8 years. I have gone to every doctor recommended. I got an MRI last January to find that my achilles is detaching and I have for a calcium deposit under it. I visited with a local Orthopedic surgeon and he was going to do surgery but he could only guarantee a 50/50 chance that the problem would be resolved. Can you send me more information on your surgery? Thank you, Karrie Eilbeck

Karrie Eilbeck

February 16, 2008 at 12:54 pm

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I am going to have surgery in 2 weeks as all other methods tried have not lessened my pain. I was given 70% chance of good to excellent results by my doctor. I was also given a recovery time of 3 weeks to 3 months depending on what he needs to do once he made the incision. I am 38 and have been in pain for the last year and a half. I have Haglunds deformity on my right foot with calcification of part of my achilles tendon. My doctor told me he would like to do a bumpectomy amd also shave off the calcium on my tendon. If this actually works and we don’t need any anchors in your experience what has been a normal recovery time. 3 weeks seems kind of impossible to me seeing as the cast imobilization without surgery was 5 weeks. Any information you could provide would be greatly appreciated.

Mike Sailer

February 21, 2008 at 9:27 pm

Reply
after 5 years of pain in my right heal the surgeon still didn’t recommend me having the op saying it would cause more pain than good, I got a second opinion and had the op on the 8/02/08 with another hospital,, althought the scar has heeled well and i had no infection the pain is unbearable walking well hobbling, 3 weeks with a cast followed by 3 with a walking rooney boot – I wish I now would have left it alone as I have been told only last week from the surgeon that i may be experiencing pain for a year and the swealing in my ancle may take two years to go down.

I also have haglunds heel in my left foot but there is no way I wil have that foot done as well.

ps.. they don’t tell you about the recovery time being so many years at pre-op I was told 6 weeks?

norman jones

March 3, 2008 at 2:53 pm

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After a surgery on my right foot for retrocalcaneous bursitis (01.22.08), I wore a soft cast for 10 days followed by a moon boot for 4 weeks. Short walks are fine, but foot tends to get sore and painful on longer walks. Swimming and cycling is just fine as these activities provide great flexibility to the ankle area. I am anxious to get back into running shape (sub 14min/5K), but I expect recovery phase may take several months (again)!

Similar surgery was performed October 2003 on left foot after 6 months of unsuccessful treatments including acupuncture, physical therapy, heel lifts, “moon boot” and hard cast. I was back racing 18 months after this surgery.

In my experience, I am extremely happy to have had these surgeries. It is a stubborn injury that causes a lot of pain. I whished I had both feet done at the same time as I have lost several years of competitive running. In 2003, surgery was not performed on the “bump” on my right foot because it was not painful at that time. My advice, stay on top of core training as your body alignment will go through a rough time adjusting to normal activity level. My left foot is completely fine now and I can’t wait for the next successful recovery!

kenneth svendsen

March 11, 2008 at 2:28 pm

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I had surgery for my Haglund’s 5 months ago by an expert in another city. My Achilles was 50% torn at the time of surgery from the bone spur digging in. That was repaired as well as removing some of my calcaneus. I can swim and bike and walk around at work, but I can’t walk any distance or speed for exercise much less run. I want to get back to running (previous Ironman triathlete) and was told I could run in 6-9 months, but even walking 30 minutes pushing a stroller causes swelling, redness, and pain — a little worse than before the surgery. Is this just part of healing or did the surgery not work? I am getting depressed.

Liz Moorehead

March 17, 2008 at 1:27 pm

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Okay, your stories are scaring me. I’m only 22 years old, I was very active up until three months ago, i got a pain and a little bump on the side of my left heel and I didnt know what it was. I tried walking it off and that only made it worse, then i went to the doctor and he there was nothing wrong with me. But it was painful, so stayed on the couch for three weeks contimplating going back home to Oklahoma so i could go to a better doctor, I didnt get to go to work the whole time. Finally I went to the doctor in ok. and he said it was Haglund’s deformity. I had surgery on it May 19th and as Norma Jones said, the pain was/is unbearable! I mean, its starting to heal, but since he cut my tendon, the bottom of my heal has excrusiating pain sometimes, especially when it rains. I havent been able to work or see any of my friends for three months and on top of that my right foot is starting to hurt now. I dont know what I’m going to do. Does the recovery really take as long as everyone is saying? Someone please email with some answers.

Melissa

June 16, 2008 at 7:01 pm

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Oh btw, my email address is hondagirl85@gmail.com

Melissa

June 16, 2008 at 7:02 pm

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I just wanted to leave a reply for Melissa. Yes, it will take time to recover from this sort of surgery. Luckily, my tendon did not get cut, but I was back to easy swimming & cycling after 6 weeks post-surgery. Today I am walking fine without any problems. Running is a different story. It gets sore and painful during and after runs (20-40min), but it is gone by the second day. However, I expect another 2-3 months before I can run easy without any pain. Don’t worry about the recovery time, you will be fine in the end!

kenneth svendsen

June 19, 2008 at 5:43 am

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Melissa,

I’m a runner whose had Haglund’s surgery on both heels. With the first heel, only bone was removed, and I was able to use an elliptical about 8 weeks after surgery, and jumped into a 70+ miles/week routine 32 weeks after surgery.

Unfortunately, however, I made the colossal mistake of seeing another doctor, who amply proved to be an athlete’s worst nightmare, for my other heel. Inexplicably, without warning or post-operative explanation, he not only cut out far more bone than we had agreed upon, but detached part of my perfectly healthy achilles tendon (which I had repeatedly and categorically forbidden him to do).

There’s no comparing the lingering pain that followed the first surgery for nearly two years (but which I was able to run fairly high mileage with) and the agony I’m still suffering from the callous second doctor’s butchery just over a year ago.

So, I think you’re going to have to be very patient because you’re dealing with the added burden of the achilles detachment.

My advice to anyone — especially athletes — considering the surgery is to find a surgeon who has had experience performing this particular surgery on athletes, so he understands the importance of getting you back on your feet as soon as possible, avoiding as much as possible the alignment screw-ups that can result from being in cast or boot, and make sure that the procedure to be performed is made utterly clear to you. Ideally, all you’ll need is a lateral incision, a little bone cut out, and NO ACHILLES detached.

Since I’ve had experience with both of the two doctors in the Lexington, KY area who perform this surgery, I’ll be happy to share in private email the name of the one who should be avoided.

Rob

July 1, 2008 at 4:41 pm

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Correction: It wasn’t 32 weeks, but rather almost exactly 16 weeks after my first surgery that I jumped into a 70 mile week (after a previous 6 weeks of daily use of an elliptical trainer).

From what I’ve gathered of other runners’ post-operative experience (after a lateral incision involving only bone removal), four months is a more or less standard amount of time it takes to get back into running. It’s when your achilles is messed with that, as my case dramatically illustrates, that recovery can be a considerably longer and more painful process.

Rob

July 4, 2008 at 6:41 am

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Question: after surgery, does your heel now look normal? It’s been 9 – 10 months, and I still have a little bump that still swells and gets red at the lateral aspect of my heel. My right heel is clearly larger than the left, and alot of that seems bony, not soft tissue swelling. After my original dr was injured and unavailable, I went to a second dr who also treats athletes and trained with the first dr. Dr #2 said he would have taken off more bone, but I may be okay — just wait and see and if it’s not better I can have the whole thing done AGAIN!!! I can run 20 – 30 minutes with minimal pain, but it hurts for 2 days after the run. Also, dr #2 said he wouldn’t have done the lateral incision bcs it led to my heel being numb from nerves being cut. So any ideas on recovery time if you did have tendon injury? And any comment on the cosmetic appearance of your post surgical heel?

Liz Moorehead

July 15, 2008 at 2:37 pm

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Liz,

My first heel (on which I simply had a lateral incision and bone removed) took around 20 months before the swelling really subsided and stopped taking a daily anti-inflammatory. However, as mentioned above, I was able to jump into fairly high (and, admittedly, fairly painful) mileage almost exactly four months after the surgery.

My other heel (which I expected to be treated as the first one was) is an entirely different story. The second doctor cut out an enormous amount of bone, inexplicably detached part of my healthy achilles, and severed nerves, which has left my heel numb on the exterior. (This nerve cutting numbers, along with the achilles detachment and the excessive amount of bone removed, and being put in a cast for five weeks, among the things I was never told by the doctor could or would happen. I would never, of course, have consented to the surgery if I’d been a properly informed patient!) At this point, around 14 months after surgery, the swelling has subsided a good deal, but the achilles area that was messed with remains a severe source of pain and stiffening, my walking is noticeably labored when I’m not limping. Even the thinnest possible socks are sometimes too constricting, and cause swelling.

I was really shafted by the doctor who “treated” me for my second heel, but I think it’s fairly clear that having your achilles detached for haglund’s deformity removal amplifies pain and protracts the recovery time involved. (My running now barely approximates to the first few weeks I began running after my first surgery.)

Rob

July 19, 2008 at 11:24 am

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By the way, there’s a lot of testimony by (mostly, I think, male) runners who’ve undergone surgery for Haglund’s Deformity on the letsrun.com message board. I find it easier to search it by using Google’s Advanced Search. For example:

http://www.google.com/search?hl=en&as_q=&as_epq=&as_oq=haglund%27s+haglund&as_eq=&num=100&lr=&as_filetype=&ft=i&as_sitesearch=letsrun.com&as_qdr=all&as_rights=&as_occt=any&cr=&as_nlo=&as_nhi=&safe=off

Rob

July 20, 2008 at 10:46 am

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Hey there–I’m another runner who has had this surgery, or, the first version of it that Rob received (lateral incision, no tendon involvement, just bone and the retrocalcaneal bursae removed). I’ve had decent results so far–I had my first surgery March 2007, and I had both feet done…kind of. My surgeon actually thought he’d be able to do the procedure endoscopically, and he did so on the left heel. On the right, he had to make a full incision. the right heel was definitely much more sore after surgery, but after about 6mos the heel bump was clearly less, whereas the left heel still had a bony protruberance. I had the left heel done, the way the right one was done the first time, in October 2007.

I’m back to *modest* running now–3 or 4 days a week–but I still get soreness after runs, and I can have flare ups and weeks when I can’t really run (and I was a 70+mi / week runner, too). I’ve started getting acupuncture though, and I think that is definitely helping with the swelling and pain. I got it once a week for a while, now once every other week. I’m still quite hopeful that the condition will resolve itself completely, and it had gotten so bad before surgery that I don’t regret getting the surgery in the least. Also, I was able to swim about 2wks after surgery, as soon as I got my stitches out (though no kicking at first). And I started doing yoga about 3wks post op. I’d really recommend both activities. As a competitive runner I was going crazy, and if I hadn’t joined a masters swim program, I think I still would be. And while physical therapy felt boring and time consuming to me, yoga is just terrific and has many of the same benefits, I would imagine.

As of now my right heel feels and looks great. My left heel is still somewhat sore and has some swelling, but people who knew my heels before the surgery say it still looks so much better…

good luck!

Emily

July 23, 2008 at 8:36 am

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I am in Canada, am 55 years old and have the largest bone protudence that my doctors have ever seen. I have always had the condition on both heels throughout my life but the last few years have seen dramatic changes on the right side that coincided with, or perhaps caused a partial achilles tear.

I still think of myself as a triathlete, but my last competition was in 2006 and I have not been able to sustain sufficient run training to compete. I have shifted more emphasis to cycling and swimming to build up my cardio.

Aside from the comment of bone removal only, do not detach any part of the achilles tendon are there any other useful comments? I see my surgeons on Friday August 8, 2008 to get a final assessment prior to surgery which would likely be in the fall.

Frank

August 6, 2008 at 2:24 pm

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I wish I would have found this website before my surgery 6/11/08. My achilles was cut to remove calcification (Haglund) and I also had a regular heel spur shaved also. The part that I really didn’t understand was the lenght of time for the recovery. I have gone back to work after 7 weeks but my foot is up under my desk. The doc says the boot needs 2-3 more weeks. I went swimming but I didn’t realize that even treading water for a long period of time would cause my foot to blow up! I’m not an athlete but I would like to be able to go back to walking again. I can’t walk to the back of Super Target, so Lord knows when I will be able to walk around the track. I guess what I can say on a positive note is to keep up with physical therapy as long as you can I have made a great deal of progress considering I went there on a Roll-about! If the PT can really break up the scar tissue it really does help. It’s 8 weeks Monday I will check back in later. By the way if any body can reccommend a good shoe after the boot let me know.

Lianne

August 8, 2008 at 11:58 am

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My personal impression (echoed by one of the doctors I saw for a second opinion after my second, awful surgery) is that physical therapy is futile when it comes to accelerating the healing of the bone, which simply takes a good year and half to do on its own. Although I was back running fairly high volume almost exactly four months after my first surgery (which involved ONLY bone removal), it was not until almost exactly two years that I could say that the aching pain was pretty much gone. (Humid weather, I find, is a really aggravating factor!)

It’s now been just over 15 months since my second surgery (or butchery), and while I’m back running decent volume, it’s relatively slow and still extremely painful, and I wear flip-flops for everything else. The aching I can tolerate well enough, as I did with the first heel; it’s the doctor’s having inexplicably cut my perfectly healthy achilles tendon that remains the source of my agony — swelling and stiffening my gait, and thereby screwing up my walking and running gait.

I’m personally skeptical about physical therapy being able to accelerate the healing of a torn or cut achilles, in contrast to a sustained period of (godawful, I know!) inactivity and immobilization.

Rob

August 8, 2008 at 1:41 pm

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Hello would just like to comment and share my personal experience. I had surgery for Haglund’s Deformity on both ankles on 08th August 2008. I had partial achilles reattachment for both ankles as well. I cannot stress enough with the rest of the comments above about finding an experienced surgeon is vital. I have had the condition on both ankles for over 10 years and was able to manage the bumps and redness of the ankles by cutting backs of shoes and using heel pads but for the last 18 months the pain spread to the achilles of both ankles and hence I made the decision for surgery.

I opted not to have casts on my ankles after surgery (to speed recovery time) but instead have been resting my ankles (raised on pillows) and only moving when absolutely necessary. I used crutches for the first week and after having the stitches removed just over a week after surgery I am able to wear normal trainers. The pain has been minimal but the swelling was quite shocking when the bandages were removed but this went away along with the bruising after the second week. I am on day 18 at the moment and am able to walk (very short distances) but I am experiencing sharp pain from both achilles if I overdo things.

So currently I am cautiously optimistic but still concerned about the true length of recovery time that my archilles will take and will only really know in a few weeks if the surgery was worth it. On a positive note the bumps are totally gone on both heels and I found the surgery relatively pain free. Will keep you posted if people are interested.

Andy

August 26, 2008 at 5:28 am

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Andy,

My experience, and that of everyone I’ve heard from, has been that the swelling persists for quite a long time — even well past the point at which I was able to begin running again — so don’t be discouraged by it. The big difference in post-operative pain between my first heel (no achilles detachment or nerve severing) and second heel (some detachment and nerve severing) is that in the latter instance it is a distinctive *burning* sensation on top of the mere aching pain resulting from the bone removal.

Rob

August 26, 2008 at 8:48 am

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Hi All,

I’m a marathon runner, and I just had surgery on 8/1/08 to correct a Haglund’s deformity with retrocalcaeal exostosis (posterior heel spurs) and associated bone fragments (sandwiched between my Achilles tendon and heel bone). My doctor (Dr. Stanley Bosta, Pittsburgh) was experienced in treating athletes for this disorder. I had the lateral incision (3-4 inch vertical incision on the lateral aspect of the heel), removal of the retrocalcaneal bursa (which was heavily calcified), removal of the bone fragments, and an osteotomy (bone cut) of my heel bone to remove the Haglund’s deformity. The great majority of my Achilles tendon was not detached from the heel bone, but a very small tendril that attached to the lateral aspect was detached to enable the bone cut. This portion of the Achilles tendon is a very small percentage of the total insertional cross length of the tendon, and it was reattached to the heel bone with a single absorbable suture (no bone anchors).

Following the procedure, my foot was wrapped with compression bandages and an ACE bandage. I was discharged from the hospital the same day on crutches wearing only a Darco Softie shoe (no rigid support). I was non-weightbearing on my treated foot for 10 days (had to get around with crutches), could stand for a few minutes on post-op day 11, started walking a little on day 12, returned to work (walking with a pronounced limp) on day 17, and today (day 25) I was told that I could start wearing a running shoe on my treated foot. I’ll be resuming a swimming routine this week, and hope to start running again in mid-October (approximately 10 weeks post-op).

At present, I don’t have much swelling at all. I had some mild swelling on Day 19 (2nd day back to work) that was well-controlled with NSAIDS and an ice pack. Since then, I haven’t even taken anti-inflammatories on a daily basis.

I’ll let you know how I do. Thank you all for your information!

Bill

August 26, 2008 at 3:42 pm

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Hi there,

I am now a 23 year old female. When I was about 15 years old I was diagnosed with “chronic achilles tendonitis” and this remained my diagnosis until I was about 20 years old. Once I was diagnosed as having haglund’s deformity on both feet, I immediately opted for the surgery, due to severe pain and and obvious increase in the size of my bumps. For both heels I had a lateral incision, and my surgeon told me he had to remove my achilles tendon’s in order to get enogh of the bone out. He did so, and I heeled VERY slowly and VERY painfully. However, now, three years after surgery most of the discomfort has subsided. I still have a slight protrusion on both heels (which I think remained fomr the initial bumps, but some of which may have been growth after surgery). I still have a hard time wearing closed-back shoes and running, due to rubbing on the back of my shoes, although I wear heel pads recommeded by my foot doctor. Does anyone have a similar problem? Are your bumps absolutely GONE after surgery? I feel like my surgeon may have left too much of a bump. which I think will cause more rubbing and just regrowth of the bone. Anyone experiencing a similar problem?

Stephanie

September 16, 2008 at 6:56 pm

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not remove.. haha…detach and reattach obviously.

Stephanie

September 16, 2008 at 6:57 pm

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At the age of 20 I was diagnosed with bursitis in my lleft ankle. Now, at the age of 43 I have a severe Haglunds deformity in both heels – the left being much more pronounced and painful. I did not even know it was on the right heel until I saw the xray. I have been to 2 podiatrists both of whom say I need surgery. One would so it himself, the other referred me to an orthopedist. The surgical podiatrist said the deformity was the largest he has ever seen. I have not been able to wear shoes with backs for years, nor walk on any surface without pain unless it is completely flat. Standing in the bathtub while showering is even painful due to the incline. I have two children and my life is active and busy. I am really concerned about recovery time – what I suffer with now is at least manageable – will it be worse with surgery? How long are you completely off your feet? How long until you can work/walk? Does flexibility eventually come back completely? If I do nothing will this condition continue to get worse? If the bump continues to grow will the tendon rupture? Which type of doctor is better for this surgery? I guess what I am asking is – should I do it? Reading the experiences here are both encouraging, and a bit scary! Any information would be well appreciated!

Katie

September 18, 2008 at 6:20 am

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Katie,

Speaking for myself, I would think that since you’re already in considerable pain a decision in favor of surgery would be easier to make. I would also think that how much pain you’ll have to endure, and for how long, will depend on whether any of your achilles tendon needs to be detached in the process of bone removal. As you can gather from all of the above, be sure to find a surgeon who’s done this particular kind of surgery before — preferably on athletes. The second (butcher of a) surgeon I made the mistake of seeing for my right foot did at least two particular things that the first (good) doctor did not do: he needlessly detached part of my achilles and cut a nerve.

It’s only recently — that is around 16 months after the butchery — that I’ve stopped waking up my girlfriend in the middle of the night with involuntary spasms of my foot caused by the cutting of the nerve in my heel. There’s still surface numbness there, but the awful burning still flares up, though with less intensity. And the only time I’m not wearing flipflops or socks is when running.

So be sure to discuss with your doctor the issues of (1) whether your achilles will need detaching and (2) damage to the nerve. If you’re lucky, all that will need to be done is a lateral incision and some bone removal, and no messing with the AT or the nerve. None of the doctors I had seen had ever seen a larger haglund’s protrusion either, so hopefully just removing some bone will be all that’s needed.

Rob

September 18, 2008 at 3:20 pm

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After over a year and a half of doctors visits, conflicting recommendations, etc., my Haglunds lump was as big as any described in the article above, the size of an egg, I guess. I’d been sedentary for years, so who knows what caused it. Putting off surgery due to work, fear, etc. Finally under constant pain, throbbing, etc., it also created severe plantar problems in my other foot due to gait compensation. Because it onset slowly, I didn’t appreciate the seriousness of my situation until some friends expressed concern over my constant pain killer intake and I realized I’d developed the habit of drinking every night to numb the pain (also the plantar pain was unbearable). Finally, I had surgery in Taiwan (where I live), where the procedure could be described as ‘in from the side’; I never did find out exactly how they did it, not like shown in this article, but they didn’t detach the tendon, that I know. Post-op pain management was perfect, i.e., there was none, I was essentially bed ridden at home for a month in recovery because I couldn’t use crutches ‘cos I couldn’t put weight on my good foot due to the plantar prob.

Anyway, it worked out great, the plantar pain also disappeared after about 3 months, I was jogging (after a 5 year hiatus) again in 6 months, lost a heap of weight, ran a half marathon in 8, and a full marathon after 2 years, my first, at the age of 41. All I can say is that the decision to operate was the correct one for me! Good luck to all who’ve posted in this forum; as I’m sure we’re all too familiar with the frustration of constant foot pain, I commend doctors who are continuing to research and develop new surgical techniques for this problem.

Dave

September 25, 2008 at 4:11 am

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To Katie and others,

Regarding the decision to operate or not, for me I was so scared at the thought of having anyone cutting my feet open, especially when they were painful enough already, that I put off the procedure for longer than I should have. It just built up so steadily that it became a normal part of my existence to have foot pain, and I just kind of accepted it.

What drove me to my decision was that I’d reached a point where the pain was constant and was getting worse, pain was also severe in my ‘good’ foot, and I just couldn’t take it anymore. Also some friends finally commented on my condition and woke me up a bit. But I had severe Haglunds for almost 2 years; crazy, I know.

From the sounds of some of your comments, I was lucky in that post op I recovered fairly quickly; I had no pain at all, some stiffness and definite weakness but was careful and diligent with rehab, and 3 years post op still no pain.

I can’t speak enough of how foot surgery changed my life and lifted me. I feel ten years younger, and have even taken up lots of new sports after being sedentary for soooo long. OK, the heel still looks different to the other one, it’s definitely thicker in the tendon and tendon attachment area, and of course the scar, but I don’t care about that. And for me though the relief of pain-free feet is soooo sweet, I can’t recommend it enough.

One thing: If you’ve had severe Haglunds, chances are you’ve already lost considerable strength in your calf muscle(s) over time due to being unable to rise up on your toes on your bad foot. Not to mention muscle shortening and an loss of elasticity in your tendon on your bad side. I know I did. So you’ll need to find a way to develop balanced strength and flexibility between your two legs post op, or else you can screw up your gait and so on and this can lead to other problems. This takes time and it helps if someone knowledgeable to guide you, examine your gait mechanics from behind, etc.

Good luck everyone!

Dave

September 25, 2008 at 5:11 am

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Hello everyone,
My name is Anastasia, I am 27, and last week on Tuesday I twisted my ankle pretty badly and heard a loud pop in doing so at work (I coach gymnastics). I have had sprained ankles before and knew this was not what was wrong in this case. A few hours after the twisted ankle I was hobbling around work and noticed what looked like a small bone sticking out near my heal. I opted to go to the emergency room later that evening and was diagnosed with achilles tendonitis. I went back to the doctor two days later with a rather large bump on the back of my heel (looking very much like the pictures on this site). This second doctor I saw was very rude and rushed me in and out saying it was just a sprained ankle. I know it is not and am concerned as it is very painful and looks like my heel bone is pushed up and popped out of place. I am curious to know if this Haglund’s Syndrome can come on suddenly like this from something like a twisted ankle or if it is more gradual over time??? I go back to the doctor on Thursday so we will see what they say then….

Anastasia

September 27, 2008 at 10:54 pm

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Anastasia, I hope you’ll share what the doctor says. If I were you, however, I would not settle with anything a doctor says who hasn’t at least obtained an x-ray of your foot (if it hasn’t improved since you twisted it).

Rob

October 2, 2008 at 3:17 pm

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Hello everyone,

Well I went back to the doctor today and they are saying it is a sprained ankle (my ankle is not the issue and doesn’t even hurt, it is the pain in my heel and back of my foot that hurts!) and that I may have a slight tear to the achilles. They did acknowledge the bump on my heel and said that it is a “boney growth” that they want to keep an eye on. I am off of work for another week and if it is in the same condition upon my next vist an MRI will be done. Which is what I was told a week ago also and an MRI was not done or scheduled on this visit (obviously). X-rays were done on my initial visit to the emergency room and I was told nothing was broken. I am concerned about this bump on the back of my heel that they are now calling a “boney growth”… any thoughts. Thank you Rob for you last reply:)

Anastasia

October 2, 2008 at 8:48 pm

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To anyone who is interested, I had my surgery on my right ankle on Wed Oct 1 2008. Even though my surgeon says that this was the largest bump he has ever operated on (he is the orthopedic surgeon for a major professional sports franchise that everyone would instantly recognize) he did not have to detach any part of the achilles to remove the bone spur and the relatively small calcified portions of my tendon.

I am on pain killers and but have already started to decrease my dosage from 12 pills for the first 24 hours to 8 pills over the second 24 hours.

I am in a bandaged splint and am not allowed to bear any weight. My follow up is in 2 weeks.

Will keep you posted on progress.

frank

October 3, 2008 at 10:18 am

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I can report that I have been completely off of all pain killers and medication for 48 hrs plus. I went back to work on Oct 6 and keep my leg elevated most of the day but the ankle still starts to swell up by 3 or so in the afternoon.

Looking forward to more mobility and getting a cast or other device that will allow me to put weight on my right leg, but that is not scheduled until Oct 17/08

frank

October 8, 2008 at 7:03 pm

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Earlier today they removed the surgery stitches and put me into a lightweight non-walking cast meaning that I still can’t start exercising or driving. Next cast switch is scheduled for Oct 31 and prognosis is that I will be out of casts by Nov 14

frank

October 17, 2008 at 9:53 am

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The fibreglass cast was removed on Oct 31 and I was given the air boot. Started distance swimming as of Oct 27 with a device known as a ‘xero sox’ a vacuum sealed sleeve that fits over the cast/wound etc. Have progressed to 70 laps per swim (25m) every other day which is just about my normal pre-surgery swim

Started moderate use of exercise bike on Nov 2 but I wear a non cycling ‘clog’ on my right foot instead of a cleated shoe. Swelling going down and mobility and strength returning very slowly.

Frank

November 5, 2008 at 2:05 pm

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For the last 2 weeks I have been able to wear a regular cycling shoe and have progressed to about 90% of my pre surgery power (speed) and about 70% of my pre surgery endurance (distance). Having physio sessions about every 4 or 5 days and still doing distance swims about 3 times a week. Doing most of my physio homework exercises most of the time. I can walk short to moderate distances with no limp or discomfort and swelling is getting to be less severe at the end of each day.

frank

November 26, 2008 at 3:56 pm

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Thanks to a decade in the Army I have had two posterior calcaneal spurs (left and right foot), and had both removed at different times using the older method mentioned- the vertical incision or lazy “S” incision- and while one surgery worked well my other feet is as bad as ever. I can’t walk very much, can’t run, and am subject to frequent, random stabbing pain.

I wonder if I could contact anyone who has had a similar experience and how (if?) it was successfully treated.

thank you.

Dave

December 6, 2008 at 9:57 pm

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Hello
My name is Brandon i am 23 i was diagnosed with haglund’sin august of 2008. I am in the army and have been contemplating on whether to have the surgery. i have read the comment that have been posted. My podiatrist gave me insoles to help with the pain but they have done nothing for me the painis still there and is gradually getting worse. the reason why i was contemplating surgery is that i am planning to make the army a carrier and i don’t feel that i would be able to preform properly with the pain i am in now, cause it hinders me i every day activities. I was just wondering what other people would do in my situation.

Thanks for reading this

brandon

December 8, 2008 at 7:00 pm

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I have haglunds issues on both feet. I’m 34 and very active…running and basketball 2-3 times a week. had a bout with achilles tendonosis in 2005 that I took 5-6 months off with. No problems since, though haglunds remains a problem. In oct ‘06 I had intermittent sharp LEFT achilles pain. MRI showed peroneal ankle tendon tear along with my haglunds on LEFT as well. Dealt with it for 2 years and had surgery on ankle tendon and haglunds on LEFT on 11/12/08. My haglunds was operated on endoscopically. 2 arthroscopic incisions (one on each side of achilles). I have no achilles tendon involvement with either of my achilles which I hear is good news. With endoscopic procedure, doctor inserts a burr to grind down the boney prominence. The burr has a hood to prevent any touching of the achilles tendon during surgery. Part of the procedure is to remove the bursa that buffers the bone from the achilles. I’m told that will grow back. At any rate, I was not put in a cast, but rather a walking boot immediately after surgery. I needed 2 crutches for 2 weeks. Then down to one crutch for another week. I am off crutches and currently wearing the walking boot through most of the day. I had no restrictions from my doctor for physical therapy so it was a goal of migrating off crutches to using just the walking boot, to getting out of the walking boot as soon as I felt comfortable. I’m getting there. Spent this past weekend completely out of the boot. Went to grocery store on Sunday and had some calf tightness. My biggest pain is doing anything involving putting weight on my toes. I’m going to physical therapy 3 times a week. My therapy began to get more aggressive last week. The ankle tendon seems to be improving greatly but the heel is still very sore. I’m hopeful to get back to playing hoops as soon as possible. Prior to surgery I asked my doctor how long before I would be running again. He said 6-9 weeks. I’m a bit skeptical. He did say the ankle tendon will heal faster than the haglunds. Any time bone is removed like that, there will be pain and swelling. He stated that 80-85% of healing will be done in first 6 weeks and the last 15-20% will be very gradual. He thought I would have pain and swelling for 6-9 months but that each week will continue to be better than the last. I buy that, but would of course like more immediate results. Part of being an athlete I suppose – impatience. I keep telling myself to take it slow.

Rob – your left procedure seems similar to what I had done with NO achilles involvement. You mentioned being able to run 70 miles a week 4 months after surgery. I’m curious if your recovery track was similar to mine at this point??? I am 26 days out of surgery.

Davis

December 8, 2008 at 9:23 pm

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Last day in walking boot was day 30 from Surgery. Walking just fine in Nike Free’s with only mild, short lived ache when getting up from a period of sitting or sleeping. in Nike Free’s. Still some discomfort with business shoes around my incisions/scars. Follow-up appt with Surgeon is today – day 36. Anxious to hear what my Dr. thinks.

Davis

December 18, 2008 at 1:33 pm

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Davis, I am curious who did your endoscopic Haglund Surgery. I currently have a small issue and have been juggling on whether to have something done about it now or not. Currently, I do have available off time and it would be financially paid for, I am also fairly young. I am in Texas, which seems to be behind in technology from the rest of the country. All but one guy wants to completely discconnect my achilles, carve out the bump and rip a portion of tendon out and reattach it. The best guy thus far wants to create a vertical cut on the achilles itself and sew the achilles back together when its done.

Here is the current symptoms, I have a non pain ful bump, probably around the size of end of a mechanical pencil erase, maybe just a fraction bigger than the end of a mechanical pencil eraser. I have minor achilles tendonitis at the insertion point, and have the suspicion that the bump probably does aggrevate the insertion point from the achilles pulling back and forth. I can wear no heeled shoes/ cloggs, soft loafers, sandals and cowboy boots. I cannot wear any dress shoes, the vast majority of casual walking shoes, or tennis shoes as it rubs my achilles tendon.

I have been juggling as stated on wether to do a surgery now or to wait. I think I would qaulify for a simple bumpsectomy since this bump is pretty small. I just have not found anyone in the Dallas area at the major hospitals that can do it. Currently, the best surgeon wants to make a vertical cut on the achilles and weaken it to get to the tiny bump. The bump is above the insertion point, which I don’t understand why they can’t just move the achilles aside and cut the little corner off.

So if you were in my place, what would you be doing? I should be a prime candidate for the endoscopic proceedure, but it would seem that noone in Texas does it. I am curious whether I should just settle with shoe modifications for now, and wait for the endoscopic proceedure to become more wide spread. Most of you all on this forum have some pretty horrid storys to tell about getting a Haglunds fixed. Again, who was your endoscopic surgeon? Bet you it wasn’t from Texas.

Bill

December 22, 2008 at 3:44 pm

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Dr. Michael C. Thompson in Omaha, NE. I believe he learned the technique from Angus McBryde who is the team physician for the University of South Carolina (I may have that slightly wrong). I have a great article about the endoscopic procedure by McBryde that I could send you. Shoot me a note at bdavis@csi-omaha.com if you’d like me to forward it to you.

I have begun faster walking and elliptical work by the way with little to no pain and am 41 days out of surgery. Still having some good pain when standing on tip toes but not unexpected.

Bill, I think the key with your issue is the amount of achilles involvement. Simple XRays would tell a doctor if there was any calcification in the achilles insertion. If so, that would be more problematic. MRI’s will tell the doctor if there is damage to or within the achilles that needs to be fixed. I had neither so was a candidate for the arthroscopic procedure. Good luck.

Davis

December 23, 2008 at 10:13 am

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Davis,

I do have a very tiny little spur in my achilles, but they haven’t even considered getting it yet. Every orthopedist I went to tries to deal with the Haglunds Bump. Its a small bump above the insertion point. I have minor insertional achilles tendonitis that acts up periodically. But I have no loss in walking, riding bikes, swimming ect. Obviously racking some weights and doing calf raises is a pretty challenge for someone that has a bump, so I no longer do calf raises with weights. Its not the end of the world for me with that. I do have naturally really tight heel cords, which is one reason why I am careful not to weight lift alot on my legs. I would REALLY love to wear normal shoes again, such as a tennis shoe. But the best Texas doctor so far wants to make a vertical cut up the achilles. The internet says they can get rid of a small bump above the insertion point without deattaching or vertically cutting the achilles. I just can’t find anyone in Texas cause we are behind in technology. All the neat new things occur in California or the East Coast, we still amputate to solve simple problems. I wonder if your surgeon knows anyone around the Dallas Fort Worth Area that does the endoscopic proceedure. I assure you if I want to deal with the two small haglunds, that I do qualify for the endoscopic proceedure.

Bill

December 24, 2008 at 11:46 pm

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Not sure Bill….seems odd that technology has yet to hit that part of the country. This technique has been around for 6 or 7 years.

Davis

December 29, 2008 at 4:29 pm

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Davis,

Got to Love Texas, yeah with all truth we really are not the best in the country medically. So don’t head this way if you need continued and up to date health care.

I made many, as in many phone calls and I found one guy in Plano Texas, which is not that far from the Dallas area. He is a Podiatrist that claims to do the Endoscopic proceedure. I am going for an office visit next week. At least he is affiliated with a major hospital. Still, he is a podiatrist and the common oppinion is that podiatrist are not true doctors. Most people feel more comfortable with orthopedic surgeons, supposedly they have more training and school. Its half of one and half of the other, the orthapedic surgeons want to go use the ancient proceedure, orthapedics may be better educated but still its a worse proceedure. Or I could let a podiatrist do it.

Question???? All that bone junk that the endoscope grinds down into I assume bone dut or bone chunks, do they leave it there???? Or do they use the endoscope to pull it out????

Bill

December 31, 2008 at 12:23 am

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Good question…the bone dust that is ground down is simultaneously sucked out using a vacuum of sorts somehow. Send me an email at bdavis@csi-omaha.com and I will return some great literature to you on the procedure.

Davis

December 31, 2008 at 11:18 am

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Davis,

You got it. I will send you an e-mail. But for the benifit of the rest of the scared, concerned or confused individuals who are planning to, have done or have had bad results of the varied surgeries of this proceedure, I have a few more questions to publically ask. But I am sending an e-mail as well.

1. Post operative pain. Obviously, if you don’t have your achilles cut on or disconnected it should be less painful than the unfortunate individuals whom got ripped apart when many did not have to. How long was the express pain? Meaning the pain it hurt after surgery just to be alive? And did it feel slightly sore? Slightly throbbing? Or did it feel like your fractured it like in a soccer match?

2. How long did you have to prop it up? Like could you sit in your computer desk and play on the computer all day? Or could you say sit through a college class after a week?

3. You had both done at the same time. Provided I found an endosopic surgeon, he seems competant and his office doesn’t have blood on the floor and is disgusting, (like most Podiatrist offices are)….. I will have surgery on the right one, the one that bothers me. HOW LONG DID IT TAKE YOU TO DRIVE or Can You not drive yet? (Its a key question) Also, did you only need crutches because you had both done at the same time?????

4. Your endoscopic cut, obviously its way better than being ripped open with a 4 to 6 inch cut, so how big was this endoscope cut, 1 inch???

Bill

January 1, 2009 at 11:03 pm

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^To answer:

1. Throbbing pain…very tolerable I thought. Pain pills are your friend. I was only on pain pills for 4 or 5 days though.

2. Prop it up as much as is possible, but no real restrictions. I work behind a desk and tried as much as possible to prop it up but couldn’t much of the time.

3. I did not have both haglunds operated on at same time. I had the left one done along with surgery on my peroneal ankle tendon on the left as well. The haglunds being the longer recovery of the two. Since it was my left, I had no problems driving. Had it been my right, I would guess I would have been able to drive at 3-4 weeks, maybe sooner depending on how good you are with controlling your foot with a walking boot on.

4. The endoscopic portals are 1-2 centimeters I would guess. Very small and naturally minimal scarring.

I am 7 weeks out. Here is how it went…right after surgery went into ace bandage, compression for wounds and a walking boot. Had stitches and compression removed at 6 days and could then shower. Was on 2 crutches for 2 weeks. Was on 1 crutch for 1 week. No crutches but still in walking boot for another week. At week 4, began walking decently around the house, etc. with Nike Free shoes on (They have no heel counter which helps). From week 4-7, pretty heavy phyiscal therapy sessions and have migrated from slowly walking to walking about 30 minutes on treadmill at 4-4.5 mph (fast walking). Can run with a limp and jumping is still not possible. Elliptical machines feel great too. I don’t notice a daily difference, but each week I seem to improve. Have been wearing regular tennis shoes to work as my business/dress shoes are still slightly uncomfortable.

The first 2 weeks on 2 crutches suck, but other than that, very manageable.

Davis

January 2, 2009 at 10:56 am

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I sent you an e-mail Davis, don’t know if you got it.

Well what you describe doesn’t sound too bad. Lots better than the Frankenstein stuff that these other Texas doctors want to do. I suppose an endoscopic incision heals pretty fast.

I am rather surprised that your heel bone didn’t heal faster than the minimal work they did on your achilles. Achilles has a pitiful blood supply and heals real slow. You must have had a sizeable bump. I suppose in the scheme of things, the amount of bone I should or need removed will be minimal. About the size of an eraser end of a pencil. If your tendon healed faster than your bone, you probably had a decent bump.

I would be risking perse a bit more than the normal person would be sort of. I am younger, which usually means things turn out better and faster, which is a plus. However, I desire freedom from Haglunds for normality not out of dire necessity, I am in no express pain. From the sounds of it, many on this forum sound like they can’t even get up stairs or down the street, their deformity was so bad. I have no problems with that at all.

I simply have shoe wear problems and problems doing leg presses and weight exercises on it. After quiting leg pressing my achilles calmed down to practically no irritation. Still the small bump remains and shoes are a problem. I really don’t want to live the rest of my hopefully decently long life like this. If I was old, I would settle for the soft loafers and slippers and not bother since I was not in any express pain. However, it would be nice to do more than walking on these legs so they are not so mismatched with the strength of my upper body.

So if the endoscopic foot surgeon that I am to visit is decent, and the proceedure is minimal, I probably will do it. And I will be happy to share my experiences on this forum.

I do have a question, the proceedure itself with the endoscope, I assume they had to weave it around your tendon. It did not irritate the tendon? And is there any risk of rupturing it by the proceedure???

Bill

January 3, 2009 at 12:03 am

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^They didn’t do any work on my achilles. It was my ankle tendon that needed minor repair/cleaning out. To answer your questions about the endoscopic cuts…they don’t even touch the achilles other than the hood of the shaver provides a buffer so the achilles does not become involved. The endoscopic incisions are very proximate to the achilles though. No chance of rupture.

Davis

January 5, 2009 at 1:19 pm

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Hi, I’m Scott. I’m 38 and have had Haglund’s surgery on my rt. heel earlier this month. Prior to surgery I had been running 40-80 MPW and racing competetively.
What led me to the surgery was gradual increase in pain & swelling back of heel increasing in severity for about 2 years. This was after confirmation by xray and MRI and after all other conservative methods: heel lifts, NSAID’s, Cortizone had failed.
I was led to believe AT removal was essential in order for the surgeon to remove the “bump”. Apparently, this is not the case. He did mention there was ’some’ AT damage in the MRI but whether or not it was essential to cut AT I don’t know.
My question is for those who have had Haglund’s w/AT removal (with screw reattachment in heel):
Describe your recovery.
Any lingering pain/numbness?
When did you start running/exercising again?
How about normal walking w/o pain?

Rob–thank you for an excellent comparsion of AT removal vs. no AT removal

Scott

January 25, 2009 at 3:45 pm

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- Scott, I’m 5 1/2 months since my haglunds resection surgery. The Surgon, a Army captain still in her internship detached my achillies tendon and removed the deformity. I use to be a very active person. I’m in the Army and did alot of running. On my spare time I did alot of climbing, and other sports that require alot of feet work. Now, I can’t run because of excruciating pain and play sports that require foot work such as; soccer, basketball etc. My R foot still gets swollen to were I can’t put a shoe or boot on, it is painfully sensitive, the J incision left a huge scar and is painful at times, numb at times and tingles at times. i was told the Surgon attached my AT with anchors to low on my heel and i limp all the time. Running is out of the question for me. I wish my Surgon would of offered me a differen’t approach to surgery.
  
  Nick H
  
  September 2, 2009 at 5:55 pm
  
  Reply
Am a 60 year old female and after well over a year of trying to manage heel pain unsuccessfully with NASIDs, orthotics, rest, ice, and many different shoe styles I had surgery to repair a (left) ruptured achilles and removal of bone spurs 11/05/08. Was casted immediately following surgery – completely non-weight bearing; first cast removed in 2 weeks and second hard cast (again non-weight bearing) reapplied for another 4 weeks. Upon removal of second cast, CAM boot applied, I began driving and physical therapy began 12/29/08.

Using small soft heel lifts, I am able to wear athletic and dress shoes. Physical therapy to rebuild strength and balance. I am able to walk nearly as well now as prior to surgery…sometimes slow to get started from a sitting position, but once up and moving feels pretty good.

Can honestly say I had absolutely NO pain following surgery; did take pain meds 24 hours following surgery (because nursing staff advised me to do so) but stopped because they caused nausea.

Had excellent surgeon here in the Chicago area; no problems with healing – everything seems to be going along perfectly; physical therapy going very well – biggest frustration is my lack of patience…its just a very, very slow recovery process.

Heidi

January 26, 2009 at 3:37 pm

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For all of you that had apples pulled from the back of your heel, did you all continue to wear shoes that irritated it or run or something??

How did those bumps get that big and that bad without aggrevation? Did you change shoe wear, go into backless or flip flops and they still got bigger?

John

February 11, 2009 at 5:19 am

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- I wear a lot of open back shoes. The shoes don’t seem to aggravate it. It is the activity. The more I exercise, play kick ball with the kids, softball, anything physical…the worse it gets.
  
  Kathy
  
  May 12, 2009 at 4:19 pm
  
  Reply
I am a 47 year old elite triathlete and had surgery for Haglund’s deformity on October 30 2008. My doctor removed the bone spur that showed on x-ray and MRI, removed scar tissue and shaved the heal bone that had a ridge of spurs (which he did not know about until he made the lateral incision). The tendon was detached to get to the heal bone and then tacked down prior to closing. I was in a tremendous amount of pain post surgery with sharp, burning pain and couldn’t walk without limping 12 weeks after. On February 3 I had a gastroc lengthening surgery done to release the tension on the achilles. My heel is still numb from the first surgery. My gastroc feels lumpy and extremely tight and sore at and around the scar. My foot pain has subsided but when I bear weight on it my gastroc and calf feel rock hard stiff. I can swim and cycle but walking for any distance at a decent pace is very difficult. Any ideas to promote healing? I’ve been massaging with vitamin E oil in hopes of breaking up the scar tissue. When will the numbness regain feeling? What stretches help? Thanks! pathpirate26@hotmail.com

Donna

February 28, 2009 at 9:10 pm

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.

LDJones

March 11, 2009 at 5:34 pm

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I am back running full speed. Occasional soreness on heel still persists but feeling pretty good 17 weeks after surgery. Played basketball for the first time on Monday. Amazingly, the harder I seem to push it, the better it feels the next day. Blood flow I suppose. Jumping ability is still not great, but gets better each week.

Davis

March 13, 2009 at 1:31 pm

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Some of you all got shafted pretty good. Unless you had spurs or an achilles that was ripped pretty good, you did not need achilles disconnect or wires, or even tendon splitting and sewing. In the past decade, the newer approaches has either been a mini open proceedure or the endoscope. The mini approach most of the time is lateral and required no achilles disconnect, if they have to disconnect it is a very small portion 10 percent and should not cripple you.

Newer arthoscopic proceedures has come out, but only a handful of surgeons currently do it and they themselves has only done a handful as its pretty brand new. It was invented in 2001 in Europe, I believe it was Sweeden came over to the US in 2004. Some of the more renowed US hospitals like John Hopkins in Maryland or California at Berkley has done around 30 or so.

Personally, if I was in some of your positions, unless your job is unstable, or your healthcare might be lost or not nearly as good a few years down the road, I would wait. Dont ever agree to have your achilles disconnected as it is not necessary unless you have severe degenerated tendons or have a massive spur. Otherwise, if any doctor says anything remote about disconnecting your tendon, don’t do it.

In my area, there are some that do the endoscope and the mini approach, I have considered it as my problem is not too bad. I consider it for the reasons of these newer approaches are not that risky and would allow me to wear closed shoes for a little while. Of course, it would seem these things come back, so it may be short lived. My question for those on this board who have had this done more than once or have big halgunds around the size of an egg. Did you all continue to run on it? Or wear shoes that irritate you? I am not a runner, I hate it. Love swimming though. I dont really have any discomfort bare foot only when I wear a hard shoe. Only reason I would yank these now is if you all had your Haglunds just grow for no reason and it got worse. Then I would do it as it should heel faster versus having an egg. Now if you all aggrevated it and continued to run on it to cause yourself to have an egg, I might consider waiting.

John

April 12, 2009 at 8:10 pm

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I had bilateral haglund’s deformity and surgery to remove bone spurs in college (1990). This was successful and I was pain free for about 10 years. The heel spurs returned, I saw a podiatrist who injected both heels with steroids. A few months later while doing step aerobics, I ruptured my right achilles tendon. After repair and prolonged non-weight bearing cast wear, it has heeled. The pain in the left foot got better with decreased activity during the healing from the rupture on the other heel. The problem on the left is getting worse, and I am going in to see an orthopod for consult. I am considering surgery again. What ever you do…don’t let anyone inject your heels with steroids. I found our too late, that increases risk of achilles rupture.

Kathy

May 12, 2009 at 4:14 pm

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I had endosopic surgery on Friday 22nd in North Texas. My bursa was removed for better visual, and while there was inflamation… no shaving of the achilles, debridement was needed. I was put in a walking boot right away. I was given Oxycodon, for which you won’t feel pain with anything if you get it. Got off of it after a day due to stomach problems, but was able to handle the pain, which was very tolerable.

I am able to move my foot, toes up and down. There is some discoloration and some swelling. Supposed to prop it up all day for the first three days, I sort of broke that rule. Had a 30 minute shower on day one, put an orthapedic shower bag over the boot. Then started eatting dinner in the kitchen. Stopped sleeping with the boot on day three, its much less hot and more comfortable to take the boot off when its not needed to be walking.

The portals are only about 0.6 mm, there are two of them, you don’t feel the stiches.

I have went to multiple surgeons over a four year period prior to consenting and got all sorts of oppinions. I got my Haglunds to be big enough in 2004 from a car accident, though…I believe I was born with them. Injury period or achilles irritation will cause them to get bigger.

I had mine dealt with when it was realtively small, the endoscope proceedure only works if you do not have large spurring at the insertion and your bump is reasonable size, not egg size.

Never agree to have an achilles disconnect proceedure for Haglunds, unless you have a pretty mean looking spur at your achilles. As that is the ONLY reason to disconnect your achilles. The vast majority of the cases of Haglunds can be done without an achilles disconnect at all, even no partial disconnect.

Many surgeons are adopting the new mini open proceedure of a lateral approach using a rasp to move the achilles to the side and cut out the offending bone. This was truley allows you to drive at 6 weeks, and also try to start athletic activity, though it will take time. Those other doctors that state that their pin, wires and achilles disconnect/ tendon splitting will have you better in 6 weeks. It won’t. it will be 6 months underneath the old way before you can consider even starting athletics. Thus, never consent to the old methods.

The endosopic approach is the least painful of the approaches. However, the approach only speeds recovery by a week or two over the mini lateral open proceedure with no achilles disconnect. The mini open proceedure is easier on the surgeon, but has more risk than the endoscopic.

The endoscope proceedure reduced sensitive scars, scar tissue, ugly scars and altered feeling. You will be in a walking boot for three to four weeks. A backless clog for another two weeks past that. If its the right foot, you can drive without the boot well in a bout a month, it can be a shorter time if you only need to drive a smaller distance or if you really decide to push your pain tolerance when driving. I recommend though taking your full month prior to, as you never know when the jerk in front of you will hit their breaks and you will need to hit yours hard also.

The endoscope proceedure allows early rehabilitation. Your in a walking boot, but only when you need to walk. I am very comfortable in taking the boot off, sleeping in bed or sitting in the chair. The boot is only needed when walking or if you have a potential of having your heel hit by another foot (such as at work) or you have pets, or your house is junky. For the endoscope proceedure, the boot is for walking support and protection only. Only critical for walking. If you have no risk of getting hit, then you are fine. I have no pets and I am careful navigating the house. So since its summer, whenever I want to take a nap or be on the computer, its too hot to be in the boot. So I take it off, sit in a chair. Can even move it some, prevents scar formation.

I will keep you all informed. I expect to be full weight bearing in two more weeks. For you athletes, it is your best surgery/ your dream surgery. As no one likes casts. And the endoscope proceedure, you can rehab nearly immediately. Referring to moving the foot and ankle. Take an injury band and slowly stretch it out at your pain tolerance. You must be very easy though with rehab early on.

Also, no matter what proceedure you end up having do not be an idiot. My feeling is many that have these removed go back to old habits of all shoes. Don’t bother. There are dress shoes that are very soft out there that can prevent it from comming back. As it can come back, usually after 10 years but not always. If you are diligent, keep your tougher shoe wear minimal, you will be better off. For example, during the summer, if you are going to the store. Still wear sandels even if you can wear shoes years after surgery. Save such shoes for athletics, wear them only when sports and work requires you to. All other times, wear the most minimal shoe that rubs as possible, as it will buy more time.

If you don’t mind going to have Haglunds done again in your life, go back to your old habits. If you don’t want to go through the recovery time again, then balance between running and other cardio. Increase swimming greatly, exercise bike and elliptical. Neither of those three will bring it back. Running, squats…etc… will eventually bring it back. Thus, I recommend doing such activities once a week or every two weeks and then doing swimming, cycling and such more often to compensate for having to run less.

Of course if you are a competitive runner, odds are you will yank this puppy and go back to full training and have to yank the puppy again in ten years. Personally, I get tired of surgery and am willing to modify to insure the bump does not come back in my life.

Leo

May 25, 2009 at 9:33 am

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It is now day nine. After day two, due to mainly constipation from the pain pills, I went cold turkey. The pain is very mild and cut in half each day. For the first week, I was on crutches/ could walk but needed two crutches to help. At about day seven, I was able to walk short distances unaided. I don’t wear my boot except outside. I don’t need it to sleep, and I actually don’t need it to walk, I can walk around barefoot. Currently to date, there has been no rupture with the endoscopic technique. I did not have any debridement on my achilles at all, they did not touch it. So I was told that I could walk unaided if I was able to. Well on day nine, I can, but slow and it does hurt a little. I often though wrap my foot and ankle area up with a couple of bandages for support. If I head to a store or outside, I wear the boot for protection from it getting wacked. I still am not “normal” walking or “normal” driving as it is my right foot. But, as I approach day ten, I would say that my healing is rapid and outstanding. I gain function back quickly and can move my foot and ankle area with minimal pain.

There is some blue bruising and discoloration, but I suppose that is not unexpected.

Unless you got yourself a major spur, don’t let any surgeon disconnect your achilles as they do not have to. Tell them to kiss your achilles a s s. If it takes two or even four oppinions to find the right doctor, then so be it. It is not necessary to disconnect, its just too many surgeons are caught into the old ways, and they are set in it. They do not want to take time off for re education. Afterall, why learn right? People seem to still flock to these guys for some reason, I suppose its failure to do their research. Medicine no longer is about helping people, its about making tons of money. For these doctors, why take the time off from making five hundred dollars every five minutes to learn a newer teachnique. For the surgeon, the newer techniques take longer time in the operating room, but the newer techniques reduce recovery time, pain, risk for the patient.

Leo

May 31, 2009 at 5:56 pm

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Today, I have collected the trash around the house and recycling (which actually is quite a lot in this house) took them out to the cans. I have grilled hamburgers for myself and baked a chocolate-chocolate chip cake from scratch. Of course I needed the help of my walking boot to pull this off, but there is no shame in that. Otherwise, I have been by myself all day. I had no help at all to do this. Took three hours to do this, a little over an hour beyond what it normally would take.

I took a walk, down my street and back in my walking boot, again no shame in using the boot. For the most part, with the exception of some serious pushing myself, I don’t even need the boot inside the house to walk to the bathroom, shower or go to the table. I can do all barefoot. I also discovered that I can pick up T-shirts off the ground with my toes once again. As well as I can carefully sit Indian style and stand on that leg/ put full 100% weight on it. Of course its only brief standing on one leg, but yet still quite an accomplishment.

At this stage, I am about 1/3 ahead in what the typical healing would be from the endoscopic, lesser invasive procedure. In five more days, day twenty post op, I have the intention to drive city streets. I will stay off of even 50 mph high way, as its high enough speed and has too many idiots that break suddenly without warning. Will drive only around neighborhoods.

I also have the intention on bench pressing in the upcoming week. The last time I bench pressed was the day before surgery, sixteen days ago. While bench press is meant for chest and triceps, it does seem to always used legs for stability and balance. Up until now, I don’t believe I would have had the stability to bench press. Now, I believe that I do. But again, it will have to be with my walking boot.

Leo

June 6, 2009 at 7:08 pm

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Oh I am on day 15 after surgery by the way and I am 24. So if you all are like WOW, part of the reason is youthful regeneration

Leo

June 6, 2009 at 7:09 pm

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Day 17 Post Op, walking around the house bear foot pretty good. Will attempt to drive soon.

Leo

June 8, 2009 at 1:04 pm

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Forget about Surgery, Cortisone Injections, Braces and Splints, Orthotics or Ultrasound Therapy.

I invented this new treatment for myself and I am almost cured in only one month. It will only cost you about 3 dollars and 15 minutes of work everyday.

I know what you are thinking… I must be crazy or trying to sell something. No, this is not an infomercial…

The 3 dollars are for a jar of Vaseline Petroleum Jelly. The rest is a daily massage that you can do it by yourself.

I have had retrocalcaneal heel spur for almost a year. I visited my doctor a couple of times, he suggested stretching exercises, advil, etc. I gained a little flexibility but no improvement in my pain.

Then I decided to tried something new… Researching online I found that the Heel spur is an accumulation of calcified deposit that attaches itself onto the calcaneus. That the tissue surrounding the calcaneus is not very vascular, and the exudate — a by-product of inflammation — has very few ways to be carried away from the area. After a period of time, this exudate will calcify (or harden) and, after repeated trauma, greater amounts of this calcified deposit will create what we call heel spur.

I thought: Maybe with massage I would increase blood circulation and hopefully dissolve the calcification. I was not very optimistic but there was not much to lose… the other option (surgery) could be worst. Three days later I realized that I was right on the money. The improvement I had in one week exceeded my expectations.

This is what I do everyday: Before going to bed I use a little vaseline to massage the heel spur and the surroundings areas. I use only my fingers and most of them from both hands. It has to be a deep massage and this requires a lot of work and they got fatigue very quickly.
After one month of this treatment I can see that the bump in the back of my heel is almost completely gone. I could say that I am 70% cured.
I hope that this information could be useful to someone with this problem. It is not life threatening but it diminish your quality of life.

Uanto

June 19, 2009 at 7:33 am

Reply
I will probably have to get surgery for my hg sometime soon. Does anyone know of an experienced surgeon in the chicago, il area? Thanks!!

paul sliwa

July 8, 2009 at 5:56 pm

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I have hagland’s, huge bone spur, and calcification of the achilles. I have done all the conservative things, and will see my ortho again next week after 30+ days in an air boot. Air boot has eliminated some of the inflamation, but has not cured the pain I have when walking, standing, etc.

I am told that because of the spur and the calcification, I will have to have the achilles detached. No way around it, it is major surgery. I trust my surgeon, he did a great job on my shoulder about 4 years ago.

I have pretty much tolerated my pain and discomfort for the past 5 years. I no longer jog or walk, but do get to do some eliptical.

I do not think they can do the “scope” if there is bone spur and calcification of the achilles. So, I have pretty much decided to have the surgery and will probably schedule it for early October–I just have to many commitments to tend to during the month of September…

I am 60 but still like to workout and exercise. I know some would think that an older person should maybe not have the surgery and just live with it…

I am dreading the initial recovery period…

Louisiana Roy

July 28, 2009 at 7:28 pm

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I have had Haglund’s for 2 years now (on my left foot for 2 years and my right foot for 1 year) and have just recently made the decision to have surgery on both feet as I can really only hobble around now. I have previously run marathons and triathlons so this has really taken a toll on my lifestyle.

I am curious because from many websites I’ve read, Haglunds comes on because of wearing high heeled shoes in women (the deformity is referred to as “pump bump”), however it seems that many active people end up with Haglunds. Has anyone heard why this is the case?

Currently I can barely walk – the pain is severe even when I’m sitting at times (and when it rains it kills!) I think I’m doing the right thing by having surgery but there are some horror stories out there! The dr. said he’d work around my achilles and remove part of the bone, I’m hoping this really resolves my problem – I’m scared that I’ll still have pain after the surgeries! The first surgery is next week…

Kristine

August 11, 2009 at 8:47 am

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- Kristine,
  
  Hope all has gone well with your surgery. I have scheduled my surgery for October 2. Just can’t get it done any earlier due to commitments through September.
  I believe my Haglands, bone spur, and calcification of Achilles is due to repeated trauma. Can’t be because of high heels, I have never worn them. Running on the road, basketball court, tennis court, etc. has probably been a major contributor to mine. Also have some tears in my AT, so guess I was eventually headed for ATR…maybe my surgery will get all issues solved and I look so forward to walking with out pain and being able to get back to some exercise…Again, hope you do well…
  
  Louisiana Roy
  
  August 18, 2009 at 6:30 pm
  
  Reply
I am currently 4 months, 20 days post surgery for Haglund’s deformity. This is my second surgery. My first was in 1983. I wish I’d never done it. I’ve had foot pain ever since. Things got really bad again after I gave birth 2 years ago and the pain was so bad that I could only wear a backless shoe with a heel. No bare feet. No flats. No sandals. I wanted to be able to enjoy chasing my son, taking walks and bike rides, and in general, just having a normal life. So, after 3 opinions, I decided to have another surgery. This time it was a Keck and Kelly calcaneal osteotomy and bursa excision. I spent 6 weeks non-weightbearing, but no cast. Another 2 doing partial weight-bearing with crutches, and then was cleared to start walking. In June, my doctor “released” me, saying my surgery was a success. I beg to differ. I’m in constant pain all the time. It’s worse than before the surgery. I finally when back earlier this month and he prescribed PT. I went for the first time yesterday and it hurt like hell, but my foot felt a little better last night. Today, it hurts again, but I’m going to keep going to PT and hope for the best. I don’t see what choices I have at this point. This is so spirit-draining! I feel like I’m 80 years old (only 44) and it’s starting to affect my knees, hips and lower back. Has anyone experienced this? Can someone tell me that it WILL get better? I could really use some positive feedback right now.
Thanks!

Renee

August 26, 2009 at 6:25 pm

Reply
- I had a simliar pain in my RH heel and was diagnosed with retorcalcenal bursitis. I had a fairly large chunk shaved off heel as well as inflammed bursae removed from my heel area. Also, TOPAZ (Achilles lengthening) preformed as well. The size of the “bump” on my heel necessitated A/T removal.
  I was in a full leg cast for 6 weeks. A moon boot for another 4 weeks.
  My experience has been it was still painful 4 months post-surgery. I cannot stress enough how important good P/T was as soon as possible following surgery.
  Give it time. Don’t quit your P/T if you still doing it. Do stretching. At 4 mos post-op, I had days when pain was still intense, especially after several continuous hours on my feet. Try to walk without limping. I had to focus on this often. If it’s still very intense after a few more weeks, call your Dr. and demand an explanation.
  I’m now almost 8 months (34 weeks) post-op. I ran (8) miles yesterday with light pain. I still ice my heel. I didn’t start running until 5-6 mos. post-op. I did alot of biking, swimming and elliptical (make sure it’s ok with Doc to do this). Try to find you’re only 44. I’m now 40. I would think chances for recovery are very good, especially if your Doc released you.
  
  Scott
  
  August 26, 2009 at 8:14 pm
  
  Reply
  - Thank you, Scott! It’s good to hear that other people have experienced what I am going through and are getting better. I went to PT today and she did a lot of deep tissue massage. I broke into a sweat, held my breath and managed to get through it without crying like a baby! My foot feels a little better and I am very hopeful that this is the solution I was looking for. I will take your advice about trying to walk normally – I know what you mean about needing to concentrate on doing this! I am still icing my heel at night and found the most fantastic “boot” – an “elasto-gel” boot that Velcro’s to my foot. It’s fabulous! I would love to hear some more stories that would boost my spirits!
    
    Renee
    
    August 27, 2009 at 3:43 pm
I have one month til my surgery…I read everything I can about this surgery, and everything you guys are writing. I do not have fear of “post op” pain, but I do have fear that maybe the surgery will not be successful. But, I have to take that chance, as I really am tired of limping through airports, hotels, around the house, etc.

I am hoping for relief, and feel that I am being realistic with my time-line expectations…

Please keep posting your successes and your progress.
I have found a site: achillesblog.com

that has lots of info…

Louisiana Roy

August 27, 2009 at 4:01 pm

Reply
I received Haglunds Resection Surgery April 23 2009. I’m currently am a Paratrooper in the 82nd Airborne Division and about September of 2008, started getting getting pain in my right heel. About Jan 2009 after a long ruck march (which I barely made because of severe pain) I realized I have a lump on my right heel. Thinking my heel is probley just swollen I just put ice on it and went on with my normal activities. After a few weeks I couldn’t run anymore or walk in normal combat boots because my heel would be in so much pain. So I went to a podiatrist and she told me I have Haglunds Deformity. She gave me heel lifts and achillies padded sleeves to wear around my ancle for padding. After wearing the heel lifts for a week I started getting “shin splints” and stop wearing them and went back for the next level of treatment, Haglunds Resection Surgery. April 23 I received the surgery. My surgon, a podiatrist resident (Army captain) detached my achillies tendon 100% from the heel, removed the deformity and re-attached my AT to my heel with 2 anchors. I was given 5 days worth of pain medication (pergaset). I had an appointment later with my doctor and told her I was in severe pain and needed pain medication still for me to be comfortable and not in agony. She refused to give me pain medication and told me to use over the counter tylanol. I couldn’t belive my ears. After about 2 weeks in a soft cast i was moved to a hard cast and was in that for another 3 weeks until i was put in a cam boot still using crutches. I couldn’t put any weight on it without being in extreme pain. After about another 2 weeks I started walking in the cam boot and about another month and a half i was moved to normal shoes. After alittle over 5 months I am getting up in the morning and still walking with a limp, my heel is still painful to touch. If I bump it on something my foot will swell up and I will be in extreme pain. Boots are now out of the question unless padded heavily. I wear a AT sleeve all the time now with 2 socks on my foot just for extra padding. I went to another doctor and he looked at my foot and told me my AT was attached to low, the way they cut the deformity off wasn’t done correctly and that is why I am having the extreme painful sensitivity. I would not recommend this surgery to anyone unless you cant even walk. I can’t even run anymore or do alot of the sports I use to play. Maybe someday but for now I have to take it easy and carry an extra ice pack with me and not to forget my over the counter tylanol….

Nick H

September 2, 2009 at 5:03 pm

Reply
- I had similar surgery (w/AT removal due to size of bump, according to my doctor)
  
  I still had some significant pain after 5 months. Swelling was nearly gone. Stretching daily seemed to reduce pain slightly.
  
  Even now at 8 months I have pain when I intensely exercise: I just did a 9.5 mile workout in 1:15 yesterday. I run in adidas supernova cushion. I iced and strectched after. During the day I had slight pain. This morning, pain and stiffness were signifcant.
  
  Compared to the pain I was in prior to surgery, it’s much less (I had constant pain, as you did) but it hasn’t gone completely away.
  
  A couple of questions:
  
  Did you have bursa(e) excision?
  
  Did you have any physical therapy after surgery?
  
  Did your doctor mention anything about scar tissue buildup?
  
  Scott
  
  September 9, 2009 at 6:15 pm
  
  Reply
Hate to hear that Nick…seems like the detachment of the achilles is the biggest issue with this surgery. I am now 10 months out and am probably back to 85% or 90%….can run full speed and play hoops as I did before. Some days the tissue around the heel is sore unexplainably. Hoping to be 100% within the next year as Rob above seemed to indicate it took 20 months for him not to take a daily anti-inflammatory. Good luck to you.

Davis

September 9, 2009 at 12:37 pm

Reply
Curious about this: I am having surgery Oct. 2. I travel a lot with my job via airplane and go through lots of airports–Atlanta, New Orleans, Orlando, Tampa, Miami, Ft. Lauderdale, Charlotte, etc.

What is your estimate of how long it will be before I should attempt travel and navigation of the airports.

Surgery will require detachment of AT…removal of bursa…

Also, reading the response by Davis is encouraging. I used to run a lot, but in recent years have been relegated to using the eliptical and stationary bike.
I do not care to reach the running again, but would really like to be able to walk 3-5 miles a day.

If I can do this is 10 months, I will consider the surgery a success–especially if I can do it with little or no pain post workout. Best of luck to all.

Louisiana Roy

September 10, 2009 at 2:57 pm

Reply
Hi! I have just gotten the news that I have Haglund’s. I am 58 (ex-runner) and am debilitated to the point that walking itself is a painful limp/shuffle. I too travel a lot and airports are a trial. They are a hardship/trial that I avoid. My orthopedic surgeon is recomending a resection/removal of the AT. He did not mention any alternatives (endoscopic or partial) but I didn’t know enough at the time to ask why not. He wants to do the surgery in early October. Does anyone know a surgeon in the Denver area that does the edoscopic procedure (non-detachment of the AT)? In the alternative, if I have to go outside Denver to get an opinion of whether endoscopic is possible given my particular condition, I can afford to travel to get that opinion.

I have reached a point that my immobility is limiting my lifestyle to an unacceptable level and I know that I need to do something. I just want to minimize the rehab.

Colorado Ray

September 12, 2009 at 10:26 pm

Reply
Surgery in one week…
Strange feeling about it–excitement and a bit of trepidation.

Looking forward to good result, hoping for uneventful procedure, and post-op with quick, clean healing of the incision…

Hagland’s procedure, spur removal, and calcification removal, with AT detachment.

Will post a report as soon after the procedure as I can…God Is Good!

Louisiana Roy

September 24, 2009 at 5:35 pm

Reply
Good Luck, Roy! I hope all goes well for you!

Renee

September 24, 2009 at 6:27 pm

Reply
Waiting to leave to go to hospital…
Gotta be there at 7:00 AM, on Schedule for 9:00 AM

Have faith in a good outcome…

Louisiana Roy

October 2, 2009 at 4:45 am

Reply
It is done….got home today at 3:00 PM
Nerve block from knee down…no pain/no feeling either

In splint with foot at 45* angle…

Block should be good for 48 hours….Doctor said all went well—will see him Monday afternoon for dressing change…

So far, so good…

Louisiana Roy

October 3, 2009 at 4:20 pm

Reply
That nerve block is the best…sucks when it wears off though.

Davis

October 7, 2009 at 10:38 am

Reply
Nearing 100%…pain has really subsided between months 10 and 12. Now onto my stupid knee problem.

Davis

October 27, 2009 at 9:02 am

Reply
I am at 3 weeks and 3 days. Go back to get cast off on 11/11. Hoping to go into boot and begin to PWB, but will probably still require crutches for a couple of weeks.

I know when I overdo it when I try to get out. Get a pretty bad burning sensation in the lower heel and some swelling in the ankle. I know when it is coming on, my cast gets pretty tight.

Right now, I have no regrets about getting the surgery.

Louisiana Roy

October 27, 2009 at 9:32 am

Reply
Curious about Physical Therapy…

When do you generally start, and how intense is it…

Louisiana Roy

October 27, 2009 at 9:35 am

Reply
- It was immediately following the removal of cast & doc’s ok. You do not want any buildup of scar tissue. It’s very basic at first and limited. Basic streching. Therapy bands. Heat and ice. Eventually, weight bearing exercises are added. It was explained to me you should do as much therapy as you can handle without further injury. Choose a PT who you get along well but will push you. I’m sure PT helped in my situation, but there was a point several weeks later where it was of limited benefit.
  
  Scott
  
  October 30, 2009 at 7:50 pm
  
  Reply
Roy – can’t really comment on your situation as it differed from my with your AT detachment and calcification removal. I never had a cast…just a walking boot and crutches. I would guess that it will be a slow but sure process for you.

Davis

October 27, 2009 at 10:26 am

Reply
I stumbled across this thread today, as I was looking for information regarding Haglund’s deformity. This is my story: I am in my 20s and ran college distance competitively and have had Haglund’s deformity for about 2.5 years now, to varying degrees of severity. Currently, I run about 50 mpw, all in Nike free’s (was running 80-90 mpw in regular shoes before this problem). However, I am constantly running through some low level amount of pain/discomfort, but I like the feeling of being in shape too much to just let myself go. I also have hopes of running marathons someday & generally miss the feeling of running without any sort of pain. Finally, as a fashionista , I really miss wearing cute shoes and don’t want to spend the rest of my life wearing flip-flops and mules.

Davis, I have had a consultation with a doctor who suggested a procedure very similar to that you described. I don’t have any sort of spurring-just two big pump bumps on each heel that make it impossible to wear “normal” shoes, thus limiting my ability to run high mileage. (It seems to get signfiicantly worse when i run over 50 mpw.) I feel like, since this thing hasn’t really gone away in nearly 3 years, that surgery is inevitable. Based on your experience, do you think it would be feasible to get surgery on both heels & be able to function in non-exercise related activities (school, grocery store, driving) in 6 weeks?

Jennifer

November 5, 2009 at 2:22 pm

Reply
More questions!!
1.) How problemmatic do you think stairs will be, if I have this surgery? (I live in a third-floor apt and was wondering if I need to look into transferring to a first floor apt, though I would rather not have to do so.)

2.) Can you run completely pain-free now, and are you able to wear normal shoes again?

Thanks, again!! I’m so happy to hear of people’s personal experiences with this thing (which, in my mind, has to be among the worst running injuries), as I feel podistrists are likely to “forget” any unsucessful surgeries.

Jennifer

November 5, 2009 at 2:56 pm

Reply
3.) Does the surgery leave a scar? Did the prominent bumps go away following surgery?

4.) I generally avoid NSAIDs, as they tend to irritate my stomach (even with food). However, has anyone found NSAIDs to be particularly helpful in actually treating the injury, as opposed to just relieving/masking pain?

jennifer

November 5, 2009 at 8:07 pm

Reply
- You train in Nike Free? They are practically a racing flat and will be more likely to aggravate heel swelling due to the fact they have less cushion than many other running shoes. You might want to try a shoe with more cushion and a large heel cup.
  
  To answer your questions, based on my experience after surgery, it was a hassle trying to climb 1 flight of steps with only 1 bad foot. I can’t imagine climbing 3 flights of steps with 2 bad feet. If you get surgery on both feet at once, I would think a first floor apt. would be essential. Would you be in a wheelchair? This surgery (w/ AT cut) requires a full leg cast. Be absolutely sure you need to have A/T cut before proceeding. The recovery time is much longer when A/T is cut. There are earlier posts (See Rob) which go into more detail.
  
  10 months post-op I can run about 90%. I still have some stiffness after a hard workout. I was very careful during recovery not to rush back into hard running. I am training in the same shoes I had prior to surgery.
  
  Yes, I have a large scar on my heel. The bump is practically non-existent, though I have had some swelling.
  
  In my case, the NSAID’s were like spitting on a forest fire. They would temporarily reduce swelling. I had a fairly large bump on my heel. I would exercise only to have pain and swelling return.
  
  Best of luck…
  
  Scott
  
  November 5, 2009 at 9:33 pm
  
  Reply
Jennifer,

I had the same surgery 5 weeks ago…Let me say that the info you are getting from individuals here is very accurate.

1. There is no way that I could have had “both” done at the same time. Difficult enough with only one.

2. Pain not that bad–ask your surgeon to get the anesthesiologist to send you home with a nerve block that will last for the firt 48 hours that you are home. After that, you will probably need nothing else.

3. You will not be able to climb stairs, walk without crutches, etc. for a bit. I am 5 weeks and I have tried (I promise you I am not a wussy) and you just can’t do it. Navigating stairs is going to be difficult, as well as trecherous. Only way I can get up and down is on by butt and scooting.

4. I hope that I do as well as Scott, and that in 10 months I am able to do 90%. I believe a realistic goal for getting back to full activity is about 12 months.

5. Do not kid yourself or convince yourself that you will have no problems. I believe that you may be inviting issues with your incision and healing process if you do to much and continually have swelling. Swelling will bring you pain, lack of circulation, which will inhibit healing, and other issues. To me, the worst thing that could happen is infection.

6. Keep in mind that when the AT is detached, it will be attached to a “fresh” bone surface of the calcaneal with anchors. I do not know the time frame for he AT to re-attach itself, but I am sure it is some weeks Post-Op.

I guess I say these things to give you additional info to help you make a good choice. A little sacrifice now in your running may pay big dividends later, while at the same time, a poor choice in how you determine to go through the recuperation time could cost you big-time later on…

Good Luck and keep us posted as to your progress.

Louisiana Roy

November 6, 2009 at 7:36 am

Reply
Don’t do both at once…it is a laborious recovery. My 1 year anniversary is next week…can say I hit 100% recovered within last month. No way I would do two at once though. Stairs will be a bear for about a month. Once you are off crutches it will be bearable though, but maybe not 3 flights. I did not have my achilles detached. That is key to this whole thing. I had an endoscopic procedure so my scars are 2 very small punch holes on both sides of the achilles. Hardly noticeable. I think I ran on a treadmill 9-10 weeks after surgery. Painful, but was running. Pain VERY gradually subsided over the course of 1 year until I can say now that it is gone. Also, I wouldn’t have been able to drive for about 6 weeks or so had it been on my right foot is my guess. Had mine done on the left though.

Davis

November 6, 2009 at 9:32 am

Reply
Hey, I really appreciate your responses. To clarify a few things, I will have the endoscopic procedure & will not have any achilles detachment. Also, the first four weeks after surgery, I have my winter break, so I can be a complete lazy bum, if I like, & have my parents take care of me and stuff. After a month, I will be pretty much on my own at school, though I have people who have offered to buy groceries for me & stuff. If all goes well, I should be out of the boot in six weeks (based on average recovery time for the doctor’s pts), though I realize one is not fully recovered for several more months. Not sure if that makes any difference with regards to the whole getting them both done at the same time, going up stairs, etc. I guess I just feel pressured to get them both done, since this is the longest break I will likely have for another 1-2 years.

Jennifer

November 6, 2009 at 4:14 pm

Reply
hi all-especially mr louisianna–i am having the same surgury friday-nov 13–i am near boston–long time runner–scared–been thru a 2 year saga……..if anyone is out there with suggestions what to do—and not do–i am all ears….thanks so much.
ntglty@comcast.net

randi

November 8, 2009 at 4:03 pm

Reply
First 2 days are probably hardest, unless you can get them to give you a nerve block that will last about 48 hours.

Purpose that you will be immobile, elevate your foot and let those around you serve you–but show appreciation so they will keep helping and waiting on you.

Plan to watch football, football, football. Get a couple of books, video DVD’s, and don’t feel bad about sleeping during the day.

I stayed in a Lazy Boy for 5 days, as it was more comfortable to sleep in than trying to keep your leg elevated in the bed.

If your foot starts to ache a little, take a couple of Tylenol Extra strength. Better to take something and catch it early so that you can manage it.

Drink a lot of liquids and watch what you eat. Try not to eat a lot junk. The only thing bad about drinking the liquids is that you have to get up and navigate to the bathroom, but that gets you up and around every once in a while.

Also, I use a back pack to transport stuff that I might need or want. I go to the kitchen on crutches and place beverage and snacks in it so that my hands are free.

Hope all goes well and that you come out of this pain free and quickly get back to your routine.

Louisiana Roy

November 8, 2009 at 4:36 pm

Reply
Oh Boy! Progress…I went to see Surgeon on Wednesday. He took the cast off (6 weeks post-op) and thought about another cast for 3 more weeks. He did a thorough examination of the incision (said it looked really good and closed well) and did some minor manipulation of my foot. Asked me if I would “strictly obey” his instructions and I could leave with a boot.

Of course I said, “Yes sir”. His instructions: Keep the crutches but go to PWB as much as you can stand it, but do not over do it and do not flex foot to much, we need to keep everything in place and not pull tendon out of anchors. Walk and put weight on heel and only when the boot is on.

Well, here it is Friday, and I was feeling pretty good. So, I decide to take a stroll down the driveway (about 40 yds. one way) and back, very slowly with no crutches (kind of looked like I was doing that wedding walk down the aisle, if you know what I mean). It was relatively pain free, with more tightness in my ankle than anyplace else. So, I am excited about that. My wife is an RN and she was not home when I went on my little excursion, but I will show her what I can do and surprise her when she gets home.

This is the first time in at least 5 years that I can sit and not have heel pain…I walked with a lot less pain than I have in a long time. I know this is only a short walk–but it is the first and I only see progressive improvement in the future.

Another milestone…I was able to stand and take a shower…do you know how hard it is for a very active 60 year old man to have to sit and take a shower???? I call that FREEDOM!

Only problem: I think the “gravy train” will be over with being waited on hand and foot. My wife has been wonderful. Her gifts of mercy and service are greatly appreciated. Now it is time for me to once again treat her like my queen…

I go back in 3 weeks and will start PT then. Can you tell that I am excites.

GOD IS GOOD…

Louisiana Roy

November 13, 2009 at 4:56 pm

Reply

Haglund’s Correction with Removal of Retrocalcaneal Spur and Transverse Achilles Tenoplasty : 2 Case Reports

by Al Kline DPM1

Podiatry Internet Journal 2 (1):1

Abstract

Introduction

Anatomy

Radiographic Evaluation

Literary Review

Vertical versus Transverse Tenoplasty

Surgical Technique

A. Vertical Incisional Tenoplasty

Once adequate bone is removed, two or three Mitek® soft tissue anchors (3.) are tapped into the bone at the region of the calcaneal tubercle. The repair is made by a modified Bunnel’s type suture technique (4.) commonly used in tendon repairs.

B. Transverse Incisional Tenoplasty

Case Presentations

Description of Procedures

Case # 1

Her radiographs reveal a classic retrocalcaneal spur or exostosis with local soft tissue inflammation and bone changes noted to the superior lateral border of the calcaneus. The following sequence of photos represents the surgical correction of her deformity using the Mitek® soft anchors.

Once, there is adequate exposure, the calcaneal tubercle as well as the superior lateral ridge of the calcaneus is removed in one piece. Here, a measuring device records the amount of bone resected. About 3 cm of bone is removed.

Once the sutures are in place, a 3-0 suture is used to approximate the paratenon and more superficial subcutaneous layers. The skin is then closed with a simple horizontal mattress suture. As you can see from the photos, the entire posterior heel is decompressed.

Case #2

Again, a J-shaped incision is made along the lateral border of the posterior heel. It should also be pointed out that the Sural nerve is more lateral to this incision.

This is a good view of the inferior tissue flap that helps to buttress the Achilles closure. Here a monofilament suture is used to buttress the inferior Achilles attachment and the subcutaneous layer is then closed.

Comment and Conclusions

References

1. P. Haglund Beitrag zur Kinik der Achillesscehne. Aschr-Orthop Chir 49:49, 1928.

2. Gerster, J.C. Plantar Fasciitis and Achilles Tendinitis Among 150 Cases of Seronegative Spondarthritis. Rheumatology and Rehabilitation, 19: 218-222, 1980.

3. Siciliano, C.J., Mozen, N.A. Rheumatoid-like Nodules Presenting as Haglund’s Deformity in an Adult, Nonarthritic Patient JFAS, 32 (5): 484-489, 1993.

4. Chao, W. et al Achilles tendon insertion: an in vitro anatomic study Foot Ankle Int. 18(2): 81-84, Feb. 1997.

5. Biehl, WC, et al Neuropathic calcaneal tuberosity avulsion fractures. Clin Orthop Relat Res. (296):8-13, November, 1993.

6. Itokazu M., et al A neglected avulsion fracture of the calcaneal tuberostiry associated with diabetes mellitus: a case report. Changgeng Yi Xue Za Zhi. 19(3): 277-280, September , 1996.

7. Marczak, L. et al Calcified Tendo Achilles Insertion: A New Surgical Approach JFS 30 (5): 457-459, 1991.

8. Niek van Kijk, C. et al Endoscopic Calcaneoplasty. The Am J of Sports Med 29:185-189, 2001.

9. Leitze, Z. et al Endoscopic Decompression of the Retrocalcaneal Space JBJS, 85:1488-1496, 2003.

10. Keck, S.W., Kelly, J.P. Bursitis of the posterior part of the heel. JBJS , 47A:267, 1965.

11. Fowler, A. , Philip, J.F. Abnormality of the calcaneus as a cuase of painful heel: its diagnosis and operative treatment. Br. J. Surg. 52:494, 1945.

12. Perlman, M. D. Enlargement of the Entire Posterior Aspect of the Calcaneus: Treatment with the Keck and Kelly Calcaneal Osteotomy JFS 31 (5), 424-433, 1992.

13. Pederson, B. Tesoro, D. Mitek Anchor System: A New Technique for Tenodesis and Ligamentous Repair of the Foot and Ankle JFS 30 (1): 48-50, 1991.

14. Maffulli, N. et al Calcific Insertional Achilles tendinopathy: reattachment with bone anchors. Am J Sports Med. 32 (1): 174-182, Jan-Feb 2004.

15. Saxena, A. Surgery for Chronic Achilles Tendon Problems JFAS 34 (3), 294-300, May/June 1995.

16. Weinraub, G.M. et al A New Method for Reattachement of the Tendo Achillis Following Retrocalcaneal Exostectomy. JFAS 37(2), March/April 1998.

17. Yu, G., et al Enhanced Tenodesis for Retrocalcaneal Surgery. JAPMA 92 (4), April 2002.

1Dr. Kline is in private practice in Corpus Christi, Texas. He can be reached by email at al@kline.net.

© Podiatry Internet Journal , 2007

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by Al Kline DPM¹

¹Dr. Kline is in private practice in Corpus Christi, Texas. He can be reached by email at al@kline.net.