What is Haglund’s syndrome?
Haglund’s syndrome is a triad of conditions, which consists of insertional Achilles tendinopathy in conjunction with inflammation between the Achilles tendon and the heel bone (retrocalcaneal bursitis) and a bony prominence on top of the heel bone (Haglund’s deformity).
An operation is only recommended as a last resort, once non-operative treatment measures for Haglund’s syndrome have been exhausted and if your symptoms remain significant.
What happens during Haglund’s syndrome surgery?
In most cases the operation is performed under general anaesthetic (whilst you are asleep). Alternatively, you can have a spinal or regional anaesthetic, which just numbs the leg.
A surgical cut is made over the back of the heel. The exact operation depends on the extent of the Haglund’s syndrome. The areas of degenerative Achilles tendon, inflamed tissue and any bony prominences around the heel are removed. If most of the Achilles tendon needs to be detached from the heel bone, it will be re-attached using special bone anchors. In a small number of cases, if a large portion of degenerative Achilles tendon is removed then another tendon (flexor hallucis longus tendon) is used to bridge the gap between the good Achilles tendon and heel bone.
Once the operation is completed, the wound is closed with stitches, local anaesthetic is given to provide pain relief for the first few hours after surgery and you will be placed in a temporary plaster cast with your foot pointing downwards to protect the re-attached Achilles tendon.
What are the risks of Haglund’s syndrome surgery?
The risks of any operation generally relate to the anaesthetic and the surgical procedure.
You will be able to discuss your anaesthetic options and associated risks with the anaesthetist before your surgery. With a general anaesthetic, the risks will vary depending on your general health.
The main surgical risks of Haglund’s syndrome surgery are listed below, but it is not exhaustive. These will be further explained in the outpatient clinic.
Blood Clots (leg or lung) – There is risk of developing a blood clot after surgery on your Achilles tendon. You will be individually assessed and may be given blood thinning medication to reduce the risk of developing a blood clot.
Nerve injury – With an operation, there is always a small risk of injuring or stretching the surrounding nerves, which can lead to numbness or even weakness. These symptoms mostly resolve in time, but they can persist.
Infection – The risk of infection with any foot and ankle operation is up to 5%. The majority are minor infections that can be simply treated with antibiotics. Occasionally, some patients can develop a deeper infection that might require another operation.
Delayed wound healing – The blood supply to the skin at the back of the ankle is poor and can cause delayed wound healing. Very occasionally you may require another operation with a plastic surgeon. Patients who smoke are at a much higher risk of this complication.
Swelling– The Achilles tendon swells after surgery as a part of the healing process and response to surgery. It takes over 12 months for the swelling to settle and the Achilles tendon will remain slightly bulkier than the other side.
Achilles tendon rupture / detachment – This a rare complication, but if it occurs a further operation may be required and the recovery period is even more prolonged. It is extremely important that you follow the post-operative instructions. Our expert physiotherapists will guide your rehabilitation to ensure that you progress in a safe manner.
Chronic regional pain syndrome – Following foot and ankle surgery a very small proportion of patients can develop chronic regional pain syndrome. Your foot becomes indefinitely painful, swollen and sensitive. If you develop this, you may require specialist care from a pain consultant.
What happens after my operation?
When will I go home after surgery?
Most patients can go home on the same day of surgery. You may require an overnight hospital stay in hospital if you have other significant medical problems.
Will I be able to walk on it after surgery?
For the first four weeks after surgery you are advised not to put any weight through your operated leg. Before you go home the physiotherapist will make sure you are safe to get around on crutches.
Also, in the first few weeks keep your leg elevated as much as possible to help reduce the swelling and aid wound healing. It is important that your cast remains dry and you may find using a waterproof cover helpful (www.limboproducts.com).
When will you see me after surgery?
You will be seen two weeks after surgery in the outpatient clinic. Your wound will be checked, your stitches removed and you will be transferred into a surgical boot with three wedges. Four weeks after surgery you can start putting weight through your operated leg.
The surgical boot should be worn continuously for eight weeks. A wedge can be removed every two weeks, to gradually bring your foot back into a neutral position. Some patients may require serial plaster casts rather than a surgical boot.
You will be seen again ten weeks following surgery to make sure everything has healed. If progress is as expected you can migrate into your own supportive footwear. You will be referred to our specialist physiotherapists who will guide your rehabilitation and monitor your progress.
When can I go back to work?
If you have a sedentary job (desk based) and are able to elevate your foot, you can return to return to work two weeks after surgery. If you have a more physically or strenuous job you may need longer off work to recover.
When can I drive?
You can start driving when you are comfortably walking in your own footwear. If you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident. Start by sitting in the car and trying the pedals, then drive round the block. Drive short distances before long ones. If you are having surgery on your left leg and drive an automatic car, you could consider driving sooner, but only if you are safe to do so.
When can I return to sports activities?
When comfortable in your own footwear gradually build up your walking distances. After Haglund’s syndrome surgery it varies how quickly people can return to sports activities and not everyone will return to their previous level. As a rough guide, you will be able to run at six months and aim to return to full sporting activities after nine months. It takes time to restore your strength and balance. You will be guided by our physiotherapists during the rehabilitation program.
When can I fly after surgery?
If you are flying after recent surgery you are at an increased risk of developing a blood clot in one of the deep veins in your body, usually the leg (deep vein thrombosis or DVT). Please ask your surgeon for individual guidance on how long to delay flying after your surgery. Also, each airline has its own regulations about flying after surgery and you will need to check with your airline before flying.
Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.
Taking vitamin C supplements for six weeks before surgery and six weeks after surgery can also be beneficial. You can purchase them from your local pharmacy or supermarket.
If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.
We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.