Patient Education · Foot & Ankle

Haglund's Deformity Repair

The bump at the back of the heel that ruins every pair of shoes. Fixing it is a bigger operation than most people expect, and worth understanding first.

Dr. Darin W. Allred Darin W. Allred, MD Board-certified orthopedic surgery & sports medicine
~1 hrTypical time for the operation
3 weeksNo weight on the foot at all
6 weeksBefore you are back in a normal shoe
6–12 moFull recovery — this one is slow

What it is

At the back of your heel bone there is a prominence. In some people it is larger and more angular, and it sits right where the Achilles tendon attaches.

Two things then happen. The bump rubs against the back of every shoe, inflaming the skin and the small sac between bone and tendon. And the tendon itself gets compressed against the bone every time your ankle flexes upward, which over years causes it to thicken and, quite often, to form bone inside itself.

People describe pain right at the back of the heel — not up in the tendon — that is worst with the first steps in the morning, worse in stiff-backed shoes, and worse going uphill. Often there is a visible, tender bump, sometimes with thickened skin over it.

What to try first, and for how long

This condition responds to non-surgical treatment more slowly than people have patience for, but it does respond.

  • Shoes without a stiff back, or with the counter cut out. Simple, and it removes the rubbing.
  • A small heel lift in both shoes, which takes tension off the attachment.
  • Eccentric calf strengthening — specific slow heel-lowering work. This is the treatment with the best evidence for Achilles problems, and it needs months, not weeks.
  • Avoiding aggressive calf stretching. Pulling the toes up hard compresses the tendon against the very bone that is irritating it, which is why stretching often makes this particular problem worse.
One thing I will not do: inject steroid into the Achilles tendon at its attachment. It can weaken the tendon and has been associated with rupture. If someone has offered you that, this is why I would say no.

Give a proper program six months before considering surgery. Most heels settle.

What the operation involves

This is where expectations matter, because the name makes it sound like shaving off a bump. It is more than that.

The Achilles attaches over a broad footprint on the back of the heel bone, and the bump sits underneath that footprint. To remove the bone properly, part of the tendon usually has to be detached, the diseased portion of tendon cleared out, the bone removed, and then the tendon reattached to the heel with anchors.

That reattachment is why the recovery is long and why you cannot put weight on it early. It is essentially an Achilles repair with a bone procedure attached, and it deserves the same respect.

How the operation goes

  1. Anesthesia. General or spinal with a block. You go home the same day, lying face down for the operation.
  2. An incision at the back of the heel, positioned away from where a shoe rubs.
  3. Detach part of the Achilles from its footprint to expose the bone underneath.
  4. Remove the diseased tendon tissue and any bone that has formed inside it.
  5. Take down the bony prominence, generously enough that it cannot keep rubbing.
  6. Reattach the tendon with anchors set into the heel bone.
  7. Splint with the foot positioned to protect the repair.

Recovery

  • Weeks 0–2No weight on the foot, in a splint. Keep the dressing on and the incision dry until your visit. Elevate hard — swelling here causes wound problems. Aspirin 81 mg twice daily for two weeks. Visit at about two weeks for stitches out, and we usually change you from the splint into a boot.
  • Week 3Weight bearing begins in the boot, using heel wedges, and builds slowly over the next four weeks. Start moving the ankle up and down out of the boot to keep it from stiffening.
  • 6 weeksFollow-up, and the transition out of the boot into regular shoes begins. Gentle biking and swimming can start.
  • 3–6 monthsCalf strengthening in earnest. Heel raises are the milestone. Walking distance builds steadily.
  • 6–12 monthsFull recovery. I tell people to expect a year before the heel is genuinely forgotten — this is one of the slower recoveries in foot and ankle surgery, and knowing that in advance makes it far easier to live with.

The risks, honestly

  • Wound healing problems The most important risk. The skin at the back of the heel is thin with a modest blood supply and it sits where shoes press. Smoking and diabetes raise this risk substantially.
  • The tendon pulls off Uncommon, and almost always from weight bearing too early.
  • Persistent pain Some heels stay sore for a long time, and a small number never fully settle. This is the honest reason to exhaust non-surgical treatment first.
  • Scar tenderness Common, since the scar sits where shoes rub.
  • Nerve irritation A small nerve runs nearby; a numb patch on the outer heel can occur.
  • Blood clots Genuinely worth taking seriously with three weeks off the foot.
This page is general education. It describes how I approach this and what most patients experience. If anything here does not match what you were told in clinic, ask — your own instructions always come first.