Monday, December 1, 2014

Lump on back of the heel: Haglund's deformity, Achilles tendonitis, Tendonosis

Lump on back of the heel is the complaint most people put as the reason for their office visit. Diagnosis for this case is:  Haglund's deformity (aka pump bump), Achilles tendonitis / Tendonosis

Symptoms:
Burning in the achilles, unable to run, jump or wear shoes due to the rubbing of the achilles. 
Throbs
Tightness in the Achilles

Conservative treatments:
See 1) NSAIDS such as motrin, etc if tolerated
2) Physical therapy
4) Ice
5) Avoid shoes that rub on that area. 
7) Platelet Injections / Stem Cell therapy


Diagnostic tests:
  • MRI will likely show degeneration, partial tears or chronic inflammation, value of such is questionable. 
  • Xrays are great for seeing the bony deformity that is causing this condition and surgical planning. 


Surgical treatment:
  • Removing of the Bump 
  • Removing of any spurs as indicated. 
  • Removing inflammed or damaged achilles tendon
  • Repair of the Achilles back into the insertion.
Below is an actual FFLC patient preop Xrays and clinical photos. 




Notice the bump right above the achilles insertion
Another view of the swelling
Side view of the painful bump
What is looks like on Xray, Multiple issues to be addressed.
1) Haglund's Deformity (top Arrow)
2) Insertional spur growing into the achilles tendon (bottom arrow)
3) bone cyst / erosion from chronic inflammatory condition. 


Patient is an active runner, pain immediately subsided after surgery. 
"Bump" no longer visible or irritated. 
4 wks in a cast, then another 2 wks in a boot that he can remove to start range of motion excercises. 
Physical therapy and boot to be used for walking at 6 weeks. 
Tens unit can be used to help with the cast disease that develops from not using the limb for some time. 


Overall, this is a very simple surgery to correct the condition.  Technique chosen by your surgeon varies.    I personally prefers to keep the achilles attachment and remove the spurs from varying angles to avoid prolonged recovery.  This also allows for anatomical repair without a question as to where mother nature intended. 



FFLC taking new patients
239 430 3668 option 2 for scheduling or you can request online through our PATIENT PORTAL. 


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