Haglund’s Deformity / Retrocalcaneal Exostosis
Retrocalcaneal exostosis is a term to describe a bone spur on the back central portion of the heel bone or calcaneus. Haglund’s deformity is a term to describe a bone spur on the superior-lateral aspect of the heel bone or calcaneus. Although both entities are stemming from the same bone and almost the same location, they are different.
First, retrocalcaneal exostoses are located directly at the insertion site or just above the insertion site of the achilles tendon on the back of the calcaneus or heel bone. This bone spur usually occurs in conjunction with insertional achilles tendonitis, but not always. There are many people who have retrocalcaneal exostoses and no pain.
Second, Haglund’s deformities or “pump bumps” are located just above and lateral to the insertion of the achilles tendon on the posterior aspect of the heel bone. To differentiate a Haglund’s deformity from a retrocalcaneal exostoses, an x-ray is typically required. Prominence of the posterior aspect of the calcaneus predisposes to the development of bursa or inflamed fluid-filled sac on on the back of the heel. The reason this entity is called a “pump bump” is that most individuals who develop this deformity are women who wear pumps.
Pain at the site of the bone spur is aggravated by pressure from shoe gear. Oftentimes, the skin overlying the spur can become thin, blistered, or callused from increased pressure from the shoe gear.
X-rays will often reveal a large bony prominence on the back of the heel just above the insertion site of the achilles tendon if a Haglund’s deformity is present, and directly at the insertion site of the achilles tendon if a retrocalcaneal exostosis is present. Most heel bones normally have a tapered or rounded posterior aspect. If the posterior aspect of the calcaneus is “squared off” then a Haglund’s deformity is present. If a retrocalcaneal exostosis is present, the bone spur is primarily located on the back center portion of the heel bone. If the retrocalcaneal exostosis is large enough, it may also involve calcification or hardening of the achilles tendon. Calcification essentially means that the achilles is turning into bone.
Initial treatment centers around reducing pressure to the back of the heel. This includes wearing open-backed shoes such as flips-flops, sandals, clogs and mules. Heel lifts are often worn inside the shoe to raise the heel up and prevent pressure by the back of the shoe while also decreasing tension or strain of the achilles tendon on the posterior aspect of the heel.
Resistant cases may require immobilization in devices such as a walking boot, below-the-knee casts and even a short period of complete non-weightbearing.
Treatment for Haglund’s deformity and retrocalcaneal exostoses are very similar. If treating a Haglund’s deformity, the “squared off” corner of the posterior superior calcaneus is removed and smoothed to make a rounded and less prominent bony prominence. Depending on how large the Haglund’s deformity is, detachment and re-attachment of the achilles tendon may be warranted.
Treating a retrocalcaneal exostosis surgically usually requires detachment of the achilles to gain access to the bone spur on the back of the heel bone. The achilles tendon most commonly inserts on and around the bone spur. Once the achilles tendon is detached from the back of the heel, the spur is resected or removed and smoothed with instrumentation. It is then customary to use tendon-bone anchors to re-attach the achilles tendon to the back of the calcaneus.
Recovery for detachment – re-attachment of the achilles tendon requires 6-12 weeks of non-weightbearing on the foot. It is important to prevent early weightbearing due to risk of tearing the achilles tendon away from the back of the heel or calcaneus.
If you have a retrocalcaneal exostosis or Haglund’s deformity, please feel free to call our offices today at 972-542-2155. Dr. Eric Silvers is a highly trained foot and ankle surgeon waiting to help you with your pain. Offices are located in both McKinney, TX and Prosper, TX.