Pump Bump

Haglund's Deformity

Treatment of Neuroma Pain

WHAT IS THIS PAINFUL BUMP ON MY HEEL?

A Haglund’s Deformity or “Pump bump” refers to a bone spur in the back of the heel bone that rubs on the inside of the shoe. This bump is usually located to the outer, upper side of the heel.  (also referred to as Mulhulland Deformity) is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

 

This condition may have a hereditary character. Women aged 20 to 30 years are often affected due to the use of high heeled shoes. Also cold weather can increase the incidence due to the more frequent use of closed back shoes and boots. Other predisposing factors include cavus foot and a tight Achilles tendon.

 

COMMON SYMPTOMS

The primary symptoms of Haglund's Deformity are an enlarged bony prominence on the back of the heel and heel pain. You might also develop blisters on your heels as a result of your shoes rubbing against the bump.

 

The pain is characterized as dull to sharp with various shoes and also in the evening after increased activities or with minor relief as it is “warmed up” during light walking and massage.

 

Will surgical correction of my PUMP BUMP improve the cosmetic appearance of my foot?

Surgical correction of a Pump bump, technically referred to as a Retrocalcaneal Exostosis is aimed both at reducing pain and restoring function, and restoring the natural look of the back of your heels.

 

CASE TESTIMONIAL

Permanent, surgical treatment of painful Pump Bumps

SURGICAL OPTIONS

The Hagland’s deformity can be removed without significant disruption of the Achilles tendon. The incision is minimal (3cm – 5cm) at the outside of the heel and sutures are removed at 2 weeks.

 

The procedure is performed in an outpatient facility under sedation and partial weight bearing is allowed after 48 to 72 hours of non weight bearing exercise.

 

Surgical care focuses mainly on the resection of the posterosuperior aspect of the calcaneus and possibly the excision of the inflamed retrocalcaneal bursa. The Achilles tendon may be debrided of diseased tissue as well, and lengthening of the gastrocsoleus complex should be considered. The goal of these procedures is to reduce the prominence in the back of the heel and the tension on the Achilles tendon.

 

TYPICAL COSTS

We are working on some standardized pricing ranges for this procedure. Because of the range of procedures and variation in requirements, we are unable to quote a cost range at this time. Please contact our offices for a diagnosis.

 

REHABILITATION / RECUPERATION / RECOVERY

In procedures that involve the Achilles tendon the healing process usually requires 6 weeks. In severe cases of deformity a calcaneal closing wedge osteotomy (Keck and Kelly) may be considered.

 

Your Doctor, nurse and clinician will help monitor and mange your recovery.

 

Maintaining a healthy diet is a key step in prevention, with some of the key nutrients including:

Protein: consuming protein will greatly assist your body in healing, delivering the cells it needs for wound care.

Vitamin C: This nutrient is found in a number of fruits and vegetables and helps the body to create a protein that helps to make skin, as well as repair and heal wounds.

Zinc: Found in red meat, shellfish, spinach and nuts and seeds.  Zinc helps the body structure the cell membranes that are pivotal in healing wounds.

 

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Treatment of Neuroma Pain

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Treatment of Neuroma Pain

Treatment of Neuroma Pain

Treatment of Neuroma Pain

Medializing Calcaneal Osteotomy

A calcaneal osteotomy is a procedure where the heel bone (calcaneal) is cut and shifted inward or outward. This is used when the heel bone has shifted out from underneath the leg and hind foot alignment is offset. After the procedure, metal screws or a plate are used to hold the heel in place. With this procedure, recovery time is at least 6 weeks of non-weight bearing in a cast or boot. After 6 weeks the patient can start applying pressure as they are able and should be wearing shoes by 8-12 weeks. Full recovery generally takes up to a year or more. Potential complications include the possibility of nerve damage, and painful hardware that may need to be removed once the bone is healed.

 

Lateral Column Lengthening

In this procedure, the lateral column is lengthened by inserting a bone graft. Specifically, the front of the heel bone is cut and a bone graft wedge is placed in to lengthen it. The graft can come from a cadaver or the patient’s hip bone. This is often done alongside the calcaneal osteotomy. Recovery time generally includes non-weight bearing or limited weight bearing in the heel. A patient should be able to transition into a shoe after 10-16 weeks. Full recovery can take up to 18 months.

 

Dorsal Opening Wedge Osteotomy

With a dorsal opening wedge osteotomy, a bone wedge is placed in the top portion of the medial cuneiform bone to push it downward. In a similar procedure, called the first tarsal metatarsal fusion, the bone is pushed down and the bones are fused into that position.

 

Tendon and Ligament Procedures

In these procedures, the posterior tibial tendon often requires removal if it is thickened or torn. The ligaments that support the arch may have been torn in the case of a flat foot. If significant damage has been done these structures may need to be repaired. In the case of a tightened Achilles tendon, there is a stretching procedure which lengthens the muscle fibers of the calf.

 

FUSION / Double or Triple Arthrodesis

To surgically correct stiff and inflexible flatfoot complications with arthritis, a double or triple arthrodesis may be performed. This is basically a fusion of one or more joints. These types of fusions are generally avoided by surgeons, but in severe cases they are used for treatment as a last resort. They can help improve stability in walking and may reduce pain. Recovery time generally includes 6-8 weeks of no weight bearing, and up to 18 months to fully recover. Complications could include nerve injury, or a non-union (where the joint fails to fuse together properly). Non-unions happen in about 5% of cases and may require additional surgery.

 

MINIMALLY Invasive Titanium Stent

Another procedure that has seen success, and is less invasive, is placement of a stent. In this treatment, a small titanium stent is placed in a natural opening between the ankle and the heel bone and helps to realign the foot and can relieve foot pain. Recovery time for this type of treatment is less than traditional surgeries. If you are looking at flat feet surgery as a treatment option, you may want to consider the less invasive stent placement.