What is Haglund’s Exotosis?
This is a benign condition which causes commonly called a ‘pump bump’ associated with posterior heel pain. Typically this occurs in women, and there is often an association of wearing high heels. It presents with a swelling over the back of the foot where the Achilles tendon attaches and causes discomfort. Over time the area can harden as well causing a bony bump as well.
If I need surgery when will I have it?
You will need to be seen in an elective foot and ankle clinic by the surgeon to clinically review your symptoms and establish the need for surgical intervention. An MRI might be needed preoperatively to see if there are degenerative changes in your Achilles tendon to manage this as well.
Will I need an operation?
When initially presenting with the condition, this can settle down with nonoperative management. This consists of heel cord stretching, changing shoe wear, and nonsteroidal anti-inflammatory medication. Using a heel insert to lift the heel out of the shoe, usually shift the contact against the heel and often relieves symptoms over time.
When do I need surgery?
When the symptoms do not settle down with conservative treatment, then surgery can be considered.
What are the risks of surgery?
The risks include bleeding, injury to a nerve, a clot in the leg or lungs(thrombosis), problems with wound healing, scar sensitivity, and Achilles tendon rupture.
What happens during the surgery?
There a different operations available for this condition and your surgeon will discuss the suitability of each for you. One of the most common is to make an incision on the side of the Achilles tendon following its insertion in to the heel bone. We will then separate half of the insertion directly off the bone and take off the bony bump as well as any bony deposits around it. If the tendon is degenerative, we will remove the parts that are unhealthy. We then reattach the tendon back into the bone using anchors that will be inserted directly into the bone. In rare cases, we may have to use another tendon to strengthen the Achilles tendon if it’s very inflamed and degenerative.
Following this, we will immobilize you in a cast and perhaps later in a boot for at least 4 to 6 weeks. We will check that your wound has healed in two weeks after the surgery for the period of immobilization, you will need to take medications to prevent a blood clot.
What happens after surgery?
Most patients do find the operative management effective for their symptoms and return to their normal activities. It is important to follow instructions with regards to the physiotherapy exercises to mobilize the foot and ankle. Once the surgeon is happy with the healing of the wound and the tendon reattachment, you can expect to have swelling and stiffness for six months to one year after the surgery, but this will settle down in the course.