Excision of Haglund deformity

Summary

This operation is performed for symptoms caused by a bony growth at the back of the heel.  The growth results as a consequence of irritation around the insertion point of the Achilles tendon and is termed a Haglund deformity.  This can rub and cause pain when wearing shoes or cause discomfort on walking/exercise.

Factors to Consider

A Haglund deformity is thought to be associated with calf tightness and wearing shoes with a stiff back.  This puts added pressures at the insertion of the Achilles tendon causing inflammation.  Repeated trauma can lead on to the development of a Haglund deformity.  The insertion of the Achilles tendon can sometimes be degenerate and inflamed as well.

It is likely that you have already tried non-surgical treatments for your foot such as pain killers, shoe modification, physiotherapy and orthotics.  If these measures have not improved your symptoms then the next logical step is to consider surgery.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation may be performed through keyhole or open surgery depending on the severity and associated tendon damage.  The bony prominence is identified and removed.  If the Achilles tendon is affected then the surgeon will removed the diseased portion and repair the tendon.   

The operation takes about 45 minutes.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk for this operation is wound problems in the first 3 weeks after surgery due to the fact that wounds around this area are slow to heal.  This means that infections can also occur, although, not commonly.  This usually settles with antibiotics but may require further surgery

Damage to nerves and blood vessels around the foot can occur but this is rare.  Any surgery to the foot increases the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a plaster.  This is kept on for the first 2 weeks to allow the wounds to heal.  You will not be allowed to weight bear during the first 2 weeks.  The surgeon will give you instructions as to when you can start weight bearing as this will depend on whether any surgery was performed to the Achilles tendon.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes about 4-6 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be approximately 80% better by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.