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Haglunds Defority

Posted by sarge on 8/03/01 at hrmin (055323)

For the past 4 years I have been in constant pain around the ankle area, and very tender on the heel. I visited a specialist and he advised that I had Haglunds in both heels. He wanted to do surgery immediately, but due to my job as a police officer, I was unable to comply that quickly. I have a few questions that I need answered. Is this surgery a cure for my pain, or only a percentage of it? I walk like a elderly man and somedays barely can even stand. How long can I expect to be off my feet..could I return to desk duty within a week? Is there any type of special shoes that I might could purchase for relieve of the pain? I have been wearing a rubber insert attached to a ace bandage for the past year, which seems to protect the heel, yet, pain is still there, and especially intense if I remove my shoes and go barefooted. What should I expect in relation to this type surgery? I appreciate all inputs as I am reluctant as to having this surgery and not getting good results afterwards. Only my pain has grown intense, and I'm even having trouble with my balance when standing. Thank you for all responses...Sarge.

Re: Haglunds Deformity

Ed Davis, DPM on 8/03/01 at hrmin (055340)

First, it is important to know if it is a true Haglund's deformity because a lot of entities on the back of heels may be lumped together. The true Haglund's deformity involves enlargement of the bone on the posterior-superior aspect (back of the heel bone and high on the back) of the calcaneus. The enlargement is ABOVE the attachment of the achilles tendon, thus it's surgical removal is fairly simple with a relatively rapid recovery time.

If the enlargement is under the achilles tendon, then part of the tendon needs to be detached in order to completely remove the tissue causing pain. This is a larger procedure although we now have better ways of re-attaching the achilles (bone anchors) that make this a more successful procedure.

The problem is often due to AICT-- achilles insertional calcific tendinitis, in which the achilles calcifies at it attachment to the back of the heel bone. This is the entity that ESWT can work for.

A lot of individuals with this problem have rearfoot varus or calcaneal varus. This is an angulation of the heel which causes the heel bone to roll inward excessively after hitting the ground. This must be addressed--if not, surgery may fail. Orthotics with a deep heel cup and rearfoot post (wedge) are a good way to neutralize the effects of rearfoot varus.

It is vital that you are seeing a doctor that thoroughly understands the differences between these entities and how those differences effect treatment.
Ed

Re: Haglunds Deformity

Ed Davis, DPM on 8/03/01 at hrmin (055340)

First, it is important to know if it is a true Haglund's deformity because a lot of entities on the back of heels may be lumped together. The true Haglund's deformity involves enlargement of the bone on the posterior-superior aspect (back of the heel bone and high on the back) of the calcaneus. The enlargement is ABOVE the attachment of the achilles tendon, thus it's surgical removal is fairly simple with a relatively rapid recovery time.

If the enlargement is under the achilles tendon, then part of the tendon needs to be detached in order to completely remove the tissue causing pain. This is a larger procedure although we now have better ways of re-attaching the achilles (bone anchors) that make this a more successful procedure.

The problem is often due to AICT-- achilles insertional calcific tendinitis, in which the achilles calcifies at it attachment to the back of the heel bone. This is the entity that ESWT can work for.

A lot of individuals with this problem have rearfoot varus or calcaneal varus. This is an angulation of the heel which causes the heel bone to roll inward excessively after hitting the ground. This must be addressed--if not, surgery may fail. Orthotics with a deep heel cup and rearfoot post (wedge) are a good way to neutralize the effects of rearfoot varus.

It is vital that you are seeing a doctor that thoroughly understands the differences between these entities and how those differences effect treatment.
Ed