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Haglunds Deformity removed six times on the R and five on the left.

Posted by Jennifer B on 8/30/02 at 16:25 (094003)

Over the last 15 years starting in 1986 I have had 11 surgeries for treatment of Haglunds Deformity. Six being on the right and five on the left. Prior to all surgeries conservative treatment has been tried. Shoe lifts, inserts, orthotics, cortisone injections, physical therapy, stretching exercises, NSAIDS with no improvement. These surgeries have averaged 2 years apart with the most recent being in 1-02. I have gradually gotten worse since this last surgery. It has been painful daily with bruising 6 months post op, excessive swelling and the end of every day. Walking, standing, sitting, sleeping, driving a car, rocking my daughter to sleep in a rocking chair are extremely painful. I am able to function doing simple day to day activities, running the vaccum, loading the dishwasher etc, only with the use of pain medication and only in short intervals. Sitting with my feet hanging down causes excessive swelling within one hour. I have been told by the surgeon this may not get any better. I have been to Rehab recently and they tell me the figure eight measurement of the right foot compared to the left has a significant difference in size. (2.5 inches) They have told me the range of motion is very poor in both ankles even though the left has not been operated on since 1996. They have told me there is such a lack of skin on the back of the ankle that proper range of motion will never be acheived again. An MRI pre-op revealed that there was significant deterioation due to steriod injections over the last 15 years and was advised not to get any more injections. I dont like taking the pain medication daily but see no other option by the end of the day. I am used to being very active. I am a registered nurse, room mother for my daughters school, head of the Northwest Missouri Girls Softball Association, and coach a boys basketball team. I have not worked in 5 months and feel I may have to resign from the other activities. Is there anything else I can try for pain relief. Is there something I can do to prevent the recurrence of the Haglunds Deformities. I should mention I let the Haglunds Deformities get so large before I agree to surgery that they tear the achilles tendon and that has to be sutured up during surgery as well. What causes these to recur in such a short period of time and why do they continue to recur. If you have any advice for me I would appreciate it. I am considering appling for disability benefits in the near future if this situation does not get better. In your opinion would I qualify for such benefits. I am a wife with a mortgage, car payments and three children. I am sick at seeing the savings dwindle due to the fact I can not work. I would appreciate any advice anyone has. I am at my wits end.

Re: Haglunds Deformity removed six times on the R and five on the left.

Ed Davis, DPM on 8/30/02 at 21:02 (094029)

Wow. You deserve the award for the most patient patient.

The Haglund's deformity is recurring due to a number of possible biomechanical factors --- calcaneal varus, rearfoot varus, 'poor' attachment of the achilles tendon to the back of the heel bone. Without going into a lot of detail, there is too much side to side motion of the heel bone when you walk. That causes bone to deposit around the area where the achilles attaches to the back of the heel bone in an attempt to stabilize the achilles' attachment.

The biomechanics of the problem must be addressed either via orthotics, surgery or a combination of both. Has the same surgeon done all of the procedures? What has been done to address the cause of the problem?
Ed

Re: Haglunds Deformity removed six times on the R and five on the left.

Dr. Z on 8/31/02 at 14:10 (094078)

There is an excellent edition in Podiatry Today which talks about what Dr. Davis has explained to you. Go to the web site it is a back issue. Oct 2000 http://www.podiatrytoday.com

Re: Haglunds Deformity removed six times on the R and five on the left.

pala on 8/31/02 at 15:22 (094082)

i really appreciate it when you, dr ed and the other docs here give us a way to further research and learn. this is a rare quality in a medical professional, at least in my experience. it says to me that you are truly interested in empowering our healing process. thanks.

Re: Haglunds Deformity removed six times on the R and five on the left.

Jennifer B on 8/31/02 at 22:12 (094102)

Thank you for your response. There have been three surgeons involved. They have each done two of the six before referring me to someone else. The first two were done by a podiatrist, the last 4 were done by an orthopedic surgeon, two seperate ones. I have seen several different podiatrists regarding this problem but are always sent to an orthopedic surgeon. I have not found a podiatrist within 100 miles that will even consider further treatment. The most aggressive they want to be is injections, which I have been advised not to take anymore. Orthotics have been tried on several occasions without success, cork and leather, rohadur, First Steps, and the last Sole Supports made with a foam casting tray. The orthotics have been altered on the inside to tilt the foot back outward. I wear tennis shoes everyday and dont buy new shoes until the soles are falling off because the bumps are so prominent they will rub holes in the backs of the shoes. Trying to get in a new pair of shoes without the holes rubbed in the back for the Haglunds causes 2 months of painful walking. Orthotics were attempted before and after surgery without success. The surgery has been to just remove the Haglunds Deformity and repair the achilles tendon tears just above the insertion. As of this far I have not had to use Mitek anchors. Also folowing surgery I am casted for 6 weeks, cam walker for 6 weeks, partial weight bearing splint, then full weight bearing. Is there some other type of surgery they could be performing to correct this or is there something else that can be tried to improve this last surgery. I have post-poned the surgery for the L at this time as the R is still very painful. An MRI, X-rays and physical examination do reveal a severe Haglunds once again with a small tear in the achilles tendon just above the insertion but again if the L should turn out like the R I will not be mobile at all. Also the scars due to the many surgeries are overlapped in several places, the skin is very tight, and full range of motion can not be achieved, the normal heel to toe walk is just on the heel because there is not enough stretch to roll from the ball of the foot to the toe, do you have any suggestions for this problem. As it is now I am 32 years old and walk like Im 85. If you should know of a physician in the Kansas City, Missouri area that you think maybe could help me, please e-mail me his name and office location. Any further suggestions you may have would be appreciated.

Re: Haglunds Deformity removed six times on the R and five on the left.

Jennifer B on 8/31/02 at 22:13 (094103)

The site wont let me get any further back than December of 2000. Thanks

Re: Haglunds Deformity removed six times on the R and five on the left.

Ed Davis, DPM on 9/02/02 at 10:28 (094212)

Jennifer:

The multiple surgeries really make things worse. It sounds like you may have to travel in order to get the care you need. Consider Dr. Lowell Scott Weil of Chicago.
Ed

Re: Haglunds Deformity removed six times on the R and five on the left.

Ed Davis, DPM on 8/30/02 at 21:02 (094029)

Wow. You deserve the award for the most patient patient.

The Haglund's deformity is recurring due to a number of possible biomechanical factors --- calcaneal varus, rearfoot varus, 'poor' attachment of the achilles tendon to the back of the heel bone. Without going into a lot of detail, there is too much side to side motion of the heel bone when you walk. That causes bone to deposit around the area where the achilles attaches to the back of the heel bone in an attempt to stabilize the achilles' attachment.

The biomechanics of the problem must be addressed either via orthotics, surgery or a combination of both. Has the same surgeon done all of the procedures? What has been done to address the cause of the problem?
Ed

Re: Haglunds Deformity removed six times on the R and five on the left.

Dr. Z on 8/31/02 at 14:10 (094078)

There is an excellent edition in Podiatry Today which talks about what Dr. Davis has explained to you. Go to the web site it is a back issue. Oct 2000 http://www.podiatrytoday.com

Re: Haglunds Deformity removed six times on the R and five on the left.

pala on 8/31/02 at 15:22 (094082)

i really appreciate it when you, dr ed and the other docs here give us a way to further research and learn. this is a rare quality in a medical professional, at least in my experience. it says to me that you are truly interested in empowering our healing process. thanks.

Re: Haglunds Deformity removed six times on the R and five on the left.

Jennifer B on 8/31/02 at 22:12 (094102)

Thank you for your response. There have been three surgeons involved. They have each done two of the six before referring me to someone else. The first two were done by a podiatrist, the last 4 were done by an orthopedic surgeon, two seperate ones. I have seen several different podiatrists regarding this problem but are always sent to an orthopedic surgeon. I have not found a podiatrist within 100 miles that will even consider further treatment. The most aggressive they want to be is injections, which I have been advised not to take anymore. Orthotics have been tried on several occasions without success, cork and leather, rohadur, First Steps, and the last Sole Supports made with a foam casting tray. The orthotics have been altered on the inside to tilt the foot back outward. I wear tennis shoes everyday and dont buy new shoes until the soles are falling off because the bumps are so prominent they will rub holes in the backs of the shoes. Trying to get in a new pair of shoes without the holes rubbed in the back for the Haglunds causes 2 months of painful walking. Orthotics were attempted before and after surgery without success. The surgery has been to just remove the Haglunds Deformity and repair the achilles tendon tears just above the insertion. As of this far I have not had to use Mitek anchors. Also folowing surgery I am casted for 6 weeks, cam walker for 6 weeks, partial weight bearing splint, then full weight bearing. Is there some other type of surgery they could be performing to correct this or is there something else that can be tried to improve this last surgery. I have post-poned the surgery for the L at this time as the R is still very painful. An MRI, X-rays and physical examination do reveal a severe Haglunds once again with a small tear in the achilles tendon just above the insertion but again if the L should turn out like the R I will not be mobile at all. Also the scars due to the many surgeries are overlapped in several places, the skin is very tight, and full range of motion can not be achieved, the normal heel to toe walk is just on the heel because there is not enough stretch to roll from the ball of the foot to the toe, do you have any suggestions for this problem. As it is now I am 32 years old and walk like Im 85. If you should know of a physician in the Kansas City, Missouri area that you think maybe could help me, please e-mail me his name and office location. Any further suggestions you may have would be appreciated.

Re: Haglunds Deformity removed six times on the R and five on the left.

Jennifer B on 8/31/02 at 22:13 (094103)

The site wont let me get any further back than December of 2000. Thanks

Re: Haglunds Deformity removed six times on the R and five on the left.

Ed Davis, DPM on 9/02/02 at 10:28 (094212)

Jennifer:

The multiple surgeries really make things worse. It sounds like you may have to travel in order to get the care you need. Consider Dr. Lowell Scott Weil of Chicago.
Ed