Fact sheet 15. Heel bump pain (Haglunds deformity/retrocalcaneal exostosis)
The Operation
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The bump is approached at surgery from the side (see illustrations)
The bone and any soft tissue that has become inflamed is removed
The achilles heel cord is repaired if necessary
The bone is shaved flat so it alters the bone contour.
Occasional an osteotomy is performed. This involves a wedge cut and screw
fixation to reduce the bulk of the heel bone.
Time of operation up to 30 minutes
Indications
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This condition affects all ages although it is usual to find the development starting
by puberty.
The back portion of the heel bone (calcaneus) forms an additional ledge of bone.
It is thought that the condition arises from mechanical pressures, which in turn
comes from the heel counter part of the shoe.
A soft swelling may arise over the bone to protect the anatomy and this is called a
bursa. In many cases bumps can be treated by orthoses, changes in shoes and local
protection. The problem with chronic large areas is that pressure builds up and
causes the skin to hurt and even blister when undertaking routine tasks. Footwear
becomes ever difficult to select.
Aim
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Consider conservative treatment and advice initially before an operation
The procedure is not common and surgery is used where problems are constant
To protect the skin and underlying tissue from degenerating
Improve shoes comfort which affects activity and function
Heel exostosis x-ray – before operation - six months later.
The scar will fade by 24 months
Consultingfoot pain. Podiatric surgical services. Mr D R Tollafield
0121 353 2444
Fact sheet 15. Heel bump pain (Haglunds deformity/retrocalcaneal exostosis)
After the operation
Things you need to know
As the incision is on the back of the heel
you need to wear a mule type shoe; one
without a back to avoid pressure
Pulling on the heel tendon will cause
discomfort so gently increase the level of
upward ankle movement
Use a splint if provided to protect the heel
or a soft pillow to raise the heel off the
supporting surface
.Avoid having two feet operated if possible
as it makes it tough on getting around
afterwards
The scar line may be painful or have
permanent numbness
Increase your walking once the wound has
healed. You will have physiotherapy
support to encourage this.
A small risk from skin infection exists
The foot will be tender for 2-5 days after
surgery but soreness may remain until
sutures are removed.
Scars tend to be thicker in patients younger
than 30 years of age but will fade in time.
Return to driving depends on your comfort
and healing, but estimate around 4 weeks
but this will depend on foot comfort as the
foot rests on the heel
The bone can regrow but this reduces with
age. I have only had to re-operate on
younger patients and this has amounted to
one in 27 years
Do not return to work until you can
walk comfortably upstairs.
Delayed healing occurs rarely but over use
by the patient is more often the cause of
such a problem
You should make sure you use crutches
at all times, or in the case of both feet a
wheel chair. Please read the post
operative information leaflet 40 with this
factsheet
It may be necessary to use a siliconised
heel pad for a short while following
surgery
Hot sweaty conditions can lead to infection
and when this happens the wound may
open and need cleaning out under
anaesthetic. This is rare but poor wound
healing can lead to unfortunate scarring.
Entrapment neuroma is rare
Consultingfoot pain. Podiatric surgical services. Mr D R Tollafield
0121 353 2444