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Haglunds Deformity Surgery

Posted by Brenda L. on 12/17/00 at 06:28 (035107)

I have been suffering with achilles tendonitis / bursitis in my right foot for about 6 or 7 years now and the left foot for about 3 or 4 years. I saw an orthopedic surgeon 2 years ago and x-rays showed 'pump bumps' on the backs of both of my feet. During these 6 years I have tried (mostly with the right foot), rest, ice, cortisone injections followed by casting for 10 days then more cortisone injections, night splint (which didn't fit properly), stretches, naprosyn, celebrex (which I have been taking 1 tablet a day every day since Dec. of 1998 and recently my family doc. increased this to 2 a day and 3 when needed), I began physical therapy for the first time Nov. 1, 2000. I have been doing heel cord stretches every day, icing every night, Celebrex twice a day & 3 when needed, iontonopheresis (sp.?) & deep friction message. My doctor also ordered me 2 night splints which I have been wearing every night (for about 2 weeks now) and they fit properly. Since beginning therapy I believe that I have seen some relief, but I'm hoping to RID myself of pain, not just improve a little. Before beginning therapy, my pain on a scale of 0 - 10, 10 being worse, on a reg. day was probably 3 getting out of bed, 4 or 5 midday, and 6 or 7 at night. Since beginning therapy my pain on most days is 1 or 2 getting out of bed, 3 or 4 midday, and 4 or 5 at night. On Dec. 12 I had another flare up after a busy weekend of shopping and other Christmas acitvities. My family doc says he thinks its time to throw in the towel and consider surgery. I went to my orthopedic surgeon again and he too says its probably time. But, a part of me wonders if I should give PT more time, and the other part of me says I've been through PT for 7 weeks now how much longer do I have to do this and will I have NO pain when I'm through? Since I am seeing some improvement am I on the right track or will I just continue to have these kinds of flare-ups and set backs? The possibility of having my achilles tendon detached and reattached really scares me and I wonder if I'm jumping into this too fast. Surgery is scheduled for 12/29/00. Any input from any Doctors or others who have been through this is greatly appreciated.
Thanks
Brenda L.

Re: Haglunds Deformity Surgery

Dr. Zuckerman on 12/17/00 at 09:57 (035111)

I want to make sure that we are talking about the same thing. Haglund's deformity is on the posterior lateral superior aspect of the heel bone and has the nickname of pump bumps. So this on the upper outside of the heel bone. This type of problem is only shoe related. Now from your description you have calicification of the achilles where it inserts into the back of the heel bone.

ESWT is a very good option for avoiding foot surgery. This is a non-invasive non-surgical procedure, that we do in the office. I know and perform the surgery that you are talking about this is a very long post-operative recovery but can resolve your problem With surgery there are alot more serious complications then with ESWT. As for the physical therapy you will need to do this now, after the surgery and I would recommend after ESWT if you should go down this road. Never rush the surgery choice. Once the surgery is done you can't turn back the clock . With ESWT you can alway have the surgery at a later date if the ESWT doesn' resolve the complaint of pain. World literature places ESWT for your specific problem at 80% sucess rate.

This board and Scott Roberts ESWT section are very good sections to start with your gathering of information . Post and read ask any one if they have had ESWT for achilles Tendonitis. I can put you in contact with patients that I have performed ESWT achilles tendonits pain if you should decide you want to speak with other about this specific ESWT condition

Good luck and use heelspurs.com as a guild for your foot health.

Re: Haglunds Deformity Surgery

Darrel H on 12/17/00 at 18:03 (035131)

I thought ESWT was not legal in the U.S... I thought one had to go to Canada for this treatment. Dr Z, let me know where this is being performed and will insurance cover this, thanks...

Re: Haglunds Deformity Surgery

Sarah on 12/22/00 at 09:24 (035294)

Hi Brenda,
I just had Haglund's surgery on my right foot this past Tuesday. I had been experiencing pain with little relief from conservative treatment for about a year. My doctor said that at this point, surgery was the only option for permanent relief. My pump bump was not connected to the tendon in any way though, so the surgery was relatively simple: he just shaved the excess bone off without needing to interfere with the tendon. Is your bump calcified at the tendon? Because I think that can create more complications--they have to release the tendon during surgery, or something.
To give you an idea of the post-op stuff: at this point I am on crutches, but only for a week or so. I have a bandage for 2 weeks, at which point my stitches will come out. I am anticipating about 3 months of soreness around the wound, but in my opinion that's much better than off-and-on soreness for the rest of my life. I've experienced the same frustration as you with flare-ups, setbacks, and miniscule improvement. I'm no doctor, but I sympathize with all your pain and would recommend surgery at this point too. Let me know what you and your doctor ultimately decide.

Re: 2nd thought

Sarah on 12/22/00 at 09:27 (035295)

Oops-- I just read Dr. Zuckerman's advice, and he makes a good point: if achilles tendonitis and calcification at the heel bone is your problem, ESWT is probably the right thing to try before surgery. At the time of my surgery I no longer had inflammation in the tendon or bursal sacs. The entire source of my pain was the pump bump, and the only way to get rid of that extra bone is through surgery. It all depends on the nature of your injury...
-Sarah

Re: 2nd thought

Dr. Zuckerman on 12/22/00 at 20:11 (035322)

Good point. When the boney deformity is the source of the pain due to the shoe hitting the boney deformity then surgery is the only way to correct the boney deformity. Haglunds deformity is different then Achilles tendon calcification

Re: Haglunds Deformity Surgery

Brenda L. on 12/23/00 at 18:06 (035341)

Thanks all for responding. I am like Darrel though and thought that ESWT was not yet approved for use in the US. If it were I'm not sure my insurance would pay for the procedure. As for as the achilles tendon calcification, I will meet with my Dr. on Wed. and he said to write down all of my questions. I asked my family doctor if he thought I was experiencing calcification and he said that he thought that I still had a lot of motion and did not think there was calcification. But, he did not see my x-rays. My orthopedic surgeon did my x-rays. Would x-rays show calcification if that is the problem? My orthopedic surgeon did not mention that there was any calcification of the tendon. He simply said that I had 'pump bumps' on both feet and that he thought that it was time to consider surgery, since I have been trying other conservative methods for so long with no relief.
Am I understanding you both though to say that if it turns out that ESWT is not an option for me, because of insurance purposes and/or not being availabe here, etc., my only alternative would probably be surgery?

Re: Haglunds Deformity Surgery

Matt Pringle on 2/18/01 at 15:52 (039323)

I have just been diagnosed with a Haglunds Bump. I am concerned as I do not know anything about it. I am from England and most of the sites are US. My consultant says that shoe inserts may solve the problem or that it may have to be shaved off. This worries me. I also play soccer and am concerned that surgery will affect this. Are there any good places to go to for advice?. Thank you.

Re: Haglunds Deformity Surgery

Louis S on 3/09/01 at 11:06 (040884)

Hi Matt

It is a difficult choice. I was diagnosed by my surgeon that I had haglunds deformity in both heels. This was after 2 years of pain, injections and physio, none which worked. The surgeon also told me I would walk out of the hospital. Well, I had the surgery, and was in a wheelchair for 1 week, before going on to crutches. It has been 2 years now since surgery, and the pain is still there. I now wear orthotics which do help, but I would advise anyone considering surgery for Haglunds to think very carefully about it. Most surgeons just do the surgery and forget about you after, and that is what happened to me. My surgeon was pretty blase about the whole incident that is why I don't trust them. A good podiatrist is alot better than an orthopaedic surgeon. Another thing you can do Matt is find a good foot surgeon in the UK. There is one doctor called Dr Balthazar based in Nottingham. I cannot remember his number but I have spoken to him and he is generally concerned about problems like this so try and look him up.

Re: Haglunds Deformity Surgery

Dr. Zuckerman on 12/17/00 at 09:57 (035111)

I want to make sure that we are talking about the same thing. Haglund's deformity is on the posterior lateral superior aspect of the heel bone and has the nickname of pump bumps. So this on the upper outside of the heel bone. This type of problem is only shoe related. Now from your description you have calicification of the achilles where it inserts into the back of the heel bone.

ESWT is a very good option for avoiding foot surgery. This is a non-invasive non-surgical procedure, that we do in the office. I know and perform the surgery that you are talking about this is a very long post-operative recovery but can resolve your problem With surgery there are alot more serious complications then with ESWT. As for the physical therapy you will need to do this now, after the surgery and I would recommend after ESWT if you should go down this road. Never rush the surgery choice. Once the surgery is done you can't turn back the clock . With ESWT you can alway have the surgery at a later date if the ESWT doesn' resolve the complaint of pain. World literature places ESWT for your specific problem at 80% sucess rate.

This board and Scott Roberts ESWT section are very good sections to start with your gathering of information . Post and read ask any one if they have had ESWT for achilles Tendonitis. I can put you in contact with patients that I have performed ESWT achilles tendonits pain if you should decide you want to speak with other about this specific ESWT condition

Good luck and use heelspurs.com as a guild for your foot health.

Re: Haglunds Deformity Surgery

Darrel H on 12/17/00 at 18:03 (035131)

I thought ESWT was not legal in the U.S... I thought one had to go to Canada for this treatment. Dr Z, let me know where this is being performed and will insurance cover this, thanks...

Re: Haglunds Deformity Surgery

Sarah on 12/22/00 at 09:24 (035294)

Hi Brenda,
I just had Haglund's surgery on my right foot this past Tuesday. I had been experiencing pain with little relief from conservative treatment for about a year. My doctor said that at this point, surgery was the only option for permanent relief. My pump bump was not connected to the tendon in any way though, so the surgery was relatively simple: he just shaved the excess bone off without needing to interfere with the tendon. Is your bump calcified at the tendon? Because I think that can create more complications--they have to release the tendon during surgery, or something.
To give you an idea of the post-op stuff: at this point I am on crutches, but only for a week or so. I have a bandage for 2 weeks, at which point my stitches will come out. I am anticipating about 3 months of soreness around the wound, but in my opinion that's much better than off-and-on soreness for the rest of my life. I've experienced the same frustration as you with flare-ups, setbacks, and miniscule improvement. I'm no doctor, but I sympathize with all your pain and would recommend surgery at this point too. Let me know what you and your doctor ultimately decide.

Re: 2nd thought

Sarah on 12/22/00 at 09:27 (035295)

Oops-- I just read Dr. Zuckerman's advice, and he makes a good point: if achilles tendonitis and calcification at the heel bone is your problem, ESWT is probably the right thing to try before surgery. At the time of my surgery I no longer had inflammation in the tendon or bursal sacs. The entire source of my pain was the pump bump, and the only way to get rid of that extra bone is through surgery. It all depends on the nature of your injury...
-Sarah

Re: 2nd thought

Dr. Zuckerman on 12/22/00 at 20:11 (035322)

Good point. When the boney deformity is the source of the pain due to the shoe hitting the boney deformity then surgery is the only way to correct the boney deformity. Haglunds deformity is different then Achilles tendon calcification

Re: Haglunds Deformity Surgery

Brenda L. on 12/23/00 at 18:06 (035341)

Thanks all for responding. I am like Darrel though and thought that ESWT was not yet approved for use in the US. If it were I'm not sure my insurance would pay for the procedure. As for as the achilles tendon calcification, I will meet with my Dr. on Wed. and he said to write down all of my questions. I asked my family doctor if he thought I was experiencing calcification and he said that he thought that I still had a lot of motion and did not think there was calcification. But, he did not see my x-rays. My orthopedic surgeon did my x-rays. Would x-rays show calcification if that is the problem? My orthopedic surgeon did not mention that there was any calcification of the tendon. He simply said that I had 'pump bumps' on both feet and that he thought that it was time to consider surgery, since I have been trying other conservative methods for so long with no relief.
Am I understanding you both though to say that if it turns out that ESWT is not an option for me, because of insurance purposes and/or not being availabe here, etc., my only alternative would probably be surgery?

Re: Haglunds Deformity Surgery

Matt Pringle on 2/18/01 at 15:52 (039323)

I have just been diagnosed with a Haglunds Bump. I am concerned as I do not know anything about it. I am from England and most of the sites are US. My consultant says that shoe inserts may solve the problem or that it may have to be shaved off. This worries me. I also play soccer and am concerned that surgery will affect this. Are there any good places to go to for advice?. Thank you.

Re: Haglunds Deformity Surgery

Louis S on 3/09/01 at 11:06 (040884)

Hi Matt

It is a difficult choice. I was diagnosed by my surgeon that I had haglunds deformity in both heels. This was after 2 years of pain, injections and physio, none which worked. The surgeon also told me I would walk out of the hospital. Well, I had the surgery, and was in a wheelchair for 1 week, before going on to crutches. It has been 2 years now since surgery, and the pain is still there. I now wear orthotics which do help, but I would advise anyone considering surgery for Haglunds to think very carefully about it. Most surgeons just do the surgery and forget about you after, and that is what happened to me. My surgeon was pretty blase about the whole incident that is why I don't trust them. A good podiatrist is alot better than an orthopaedic surgeon. Another thing you can do Matt is find a good foot surgeon in the UK. There is one doctor called Dr Balthazar based in Nottingham. I cannot remember his number but I have spoken to him and he is generally concerned about problems like this so try and look him up.