What is Haglund’s and Bursa Removal?

Haglund's deformity, often referred to as "pump bump," is a bony enlargement on the back of the heel. This condition can lead to irritation and inflammation of the surrounding soft tissues, including the bursa - a small fluid-filled sac that acts as a cushion between the bone and the Achilles tendon. Haglund’s deformity is also known as retrocalcaneal bursitis or Haglund’s bursa.

Haglund's and bursa removal typically refers to a surgical procedure aimed at treating Haglund’s deformity and the associated painful bursitis (inflamed bursa). The surgery typically involves:

  • Haglund's Deformity Resection: This involves the surgical removal of the bony enlargement on the heel.
  • Bursectomy: Removal of the inflamed bursa that is causing pain and irritation. 

Indications for Haglund’s Bursa Removal

Haglund’s and bursa removal is typically recommended when conservative treatments such as rest, ice, physical therapy, or orthotic devices have failed to resolve symptoms of Haglund’s deformity, such as persistent pain at the back of the heel, swelling, and inflammation, or when you have difficulty wearing footwear due to the bony enlargement.

Preparation for Haglund’s and Bursa Removal

In general, Haglund’s and bursa removal typically include the following:

  • A thorough medical evaluation, including a review of your medical history, physical examination of the foot, laboratory tests, any allergies, and any current medications or supplements you are taking.
  • Imaging studies such as X-rays and CT scans, to assess the extent of the deformity and inflammation and plan the surgical approach.
  • Your surgeon may instruct you to avoid certain medications and supplements that can thin the blood and increase the risk of bleeding during surgery.
  • Guidelines on when to stop eating and drinking before the surgery (typically 8 hours before).
  • Instructions to stop smoking and limit alcohol consumption to improve healing and reduce complications.

Procedure for Haglund’s and Bursa Removal

Haglund’s and bursa removal is usually an outpatient procedure, meaning you can go home the same day as your surgery. In general, the procedure may involve the following steps:

  • Anaesthesia: The surgery is usually performed under general anaesthesia or sedation and local anaesthesia.
  • Incision: The surgeon makes an incision on the back of the heel to expose the Haglund’s deformity and the inflamed bursa.
  • Exposure: The skin and the muscle are carefully retracted to expose the treatment area. In some cases, the Achilles tendon may be partially detached and then reattached to provide better access to the bony prominence and the bursa.
  • Bursa Removal: The inflamed bursa is identified and carefully excised. This step helps to reduce pain and inflammation caused by the friction between the bone and the Achilles tendon.
  • Bony Deformity Removal: Using specialised instruments, the surgeon removes the bony prominence (Haglund’s deformity) to prevent further irritation of the tendon and bursa. Debridement of the Achilles tendon may also be performed if required.
  • Closure: The incision is closed with sutures, and a sterile dressing is applied.

Postoperative Care and Recovery

In general, postoperative care and recovery for Haglund’s and bursa removal may include the following:

  • Immobilisation: The patient may need to wear a boot or cast to immobilise the foot and protect the surgical site. This helps ensure proper healing of the tendon and surrounding tissues.
  • Pain Management: Pain and anti-inflammatory medications are prescribed to manage postoperative pain and reduce inflammation.
  • Physical Therapy: Once the initial healing phase is complete, physical therapy is initiated to restore range of motion, improve strength, and ensure proper function of the Achilles tendon and surrounding muscles.
  • Follow-up Appointments: Regular follow-up visits are scheduled to monitor the healing process, assess for any complications, and adjust the rehabilitation plan as needed.

Risks and Complications

Risks and complications associated with Haglund’s and bursa removal may include:

  • Infection
  • Bleeding
  • Nerve damage
  • Delayed healing
  • Recurrence
  • Side effects of anaesthesia