There are 2 primary conditions that may cause pain on the back of the heel. These include a Haglund’s deformity and Insertional Achilles tendonitis.
Haglund’s deformities or “pump bumps” are located just above where the Achilles tendon inserts onto the heel bone. Prominence of the back of the heel bone speeds the development of a bursa, which is an inflamed fluid-filled sac on the back of the heel. Most heel bones are normally round in the back but when a Haglund’s deformity is present, it is enlarged and square.
Insertional Achilles tendonitis is inflammation of the Achilles tendon as it inserts on the back of the heel bone. It commonly presents with a gradual onset, often leading to chronic heel pain and swelling. The back of the heel becomes very tender and puffy with a lot of pain wearing closed toed shoes. Pain is aggravated by increased activity (walking or running) and pressure from shoe gear. Oftentimes, a bony prominence is appreciated within the Achilles tendon. X-rays often, but not always, show bone spurs inside the Achilles tendon.
Initial treatment for both Haglund’s Deformity and Insertional Achilles Tendonitis centers on reducing pressure to the area. This includes wearing open-backed shoes such as sandals or clogs. Prescription non-steroidal anti-inflammatories topically or orally, steroid therapy, and various physical therapy methods such as stretching, K-Laser Cold Laser treatments, ultrasound and iontophoresis can be used. Heel lifts are often used to lift the heel and decrease tension or strain of the Achilles tendon on the back of the heel. Resistant cases may require immobilization in devices such as a walking boot or below-the-knee cast and a short period of complete non-weight bearing is often needed.
If no relief is accomplished with the conservative options, surgery may be indicated. Surgical correction for each condition is similar, however depending on the size of the Haglund’s deformity, a detachment and reattchment of the Achilles tendon is not always needed, decreasing the recovery time. In some cases the tendon itself is partially torn and needs to be repaired. If there is a bursa is present, it is also removed. If the Achilles tendon is shortened or too tight, lengthening of the tendon is performed as well. The surgical procedure is most commonly performed as an outpatient procedure allowing you to recover and rest in the comfort of your own home. Post-operative pain medications are prescribed and are usually only needed for a few days. Drs. Silvers, Hadfield and Lloyd will perform these procedures at Medical Center of McKinney, Centennial Medical Center, Baylor Medical Center at McKinney, THR Craig Ranch Surgery Center or Preston Surgery Center.
The surgical procedure for insertional Achilles tendonitis with a heel spur has a somewhat longer recovery than a Haglund’s deformity because the spur is within the tendon, requiring part or all of the Achilles tendon to be detached and reattached. The bone spur is removed and the heel bone is modeled to a more anatomical shape in a similar way to a Haglund’s procedure. The Achilles tendon is then re-attached to the newly modeled heel bone with the use of bone anchors. After the procedure a posterior splint, or half cast, is placed which helps support the foot and ankle and protect it from movement and pressure. A full cast is then applied and is usually needed for 4-6 weeks, being changed every two weeks. The recovery takes a minimum of 6 weeks non weight bearing on the surgical foot and after that a walking boot is used. Physical therapy is a very important part of the recovery process to promote better range of motion and strength.
The procedures for both a Haglund’s deformity and for insertional Achilles Tendinitis are highly successful in significantly reducing your pain, allowing you to return to your desired activities. The doctors at Advanced Foot and Ankle Center are well trained and experienced in treating both conditions and look forward to seeing you to discuss your particular case.
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