Haglund's deformity excision is an operation to remove a prominent bony bump at the back of the heel that causes irritation of the Achilles tendon and bursa, producing pain known as 'pump bump'.
An incision is made alongside the Achilles tendon. The prominent bone at the posterosuperior corner of the calcaneus is resected. The inflamed retrocalcaneal bursa is removed. If the Achilles tendon is detached during the procedure, it is reattached with suture anchors. The operation takes 45-90 minutes.
Surgery is recommended when conservative measures including footwear modification, heel raises, padding, anti-inflammatory medication, and physiotherapy have failed to relieve symptoms.
Open-backed shoes, heel raises, Achilles stretching, anti-inflammatory gel, corticosteroid injection (into the bursa, not the tendon), and ice.
X-ray and MRI to assess the deformity and tendon. Day-case procedure.
Relief of posterior heel pain in approximately 80-85% of patients.
The posterior heel skin heals slowly.
Heel swelling for several weeks.
Some patients have persistent symptoms.
If the tendon attachment is disrupted, prolonged rehabilitation is needed.
Numbness on the outer foot.
Wound infection.
If excessive bone is removed weakening the tendon insertion.
General or regional anaesthesia with ankle block.
Walking boot for two to six weeks (longer if tendon was detached and repaired). Gradual return to normal footwear. Full recovery three to six months.
Reviews at two weeks and six weeks.
It is partly inherited bone shape and partly related to footwear. Rigid-backed shoes (hence 'pump bump') press on the bony prominence, inflaming the bursa between the bone and the Achilles tendon.