Haglund Spur Surgery

What is a Haglund spur?

A Haglund spur is a spur of bone which forms at the back of the calcaneus (the heel bone). Sometimes the spur of bone causes pain by rubbing on the back of your shoes. The spurs are next to the lower end of the achilles tendon and sometimes can cause pain by irritating the attachment of the tendon. The tendon is usually protected from the bone by a thin pad of tissue known as the retrocalcaneal bursa. This bursa can become inflamed and painful. In some people the spur of bone actually grows into the attachment of the achilles tendon causing pain. 

People with a Haglund spur will notice a firm lump at the back of the heel. This is often painful and can rub on the back of the shoe. 

How is the diagnosis made?

An x-ray is obtained to look for any bone spur and to tell whether it is abutting against the achilles tendon or growing into it. Sometimes a MRI scan is obtained, in particular to look for degeneration in the achilles tendon or for inflammation in the retrocalcaneal bursa (the fluid filled pad between the Haglund spur and the achilles tendon).

What are the treatments?

Sometimes the problem can be kept at bay with modifications to footwear to relieve the rubbing. If the main cause of pain is inflammation of the retrocalcaneal bursa then an injection of steroid might help to settle this down. The injection is performed under the guidance of an ultrasound scan to minimise the risk of damage to the achilles tendon.

What about surgery?

Surgery is the only way of removing a lump of bone. Surgery is never obligatory for this condition, but if the spur of bone is causing pain or other restrictions then it is worth seriously considering this option. 

The type of surgery required will depend on whether the bone spur is growing in front of the Achilles tendon or inside it. If the spur is growing into the tendon then it is necessary to take the tendon off to remove the bone spur then reattach it.

How is surgery carried out?

Surgery is usually carried out under general anaesthetic, either as a day case or with one night stay. Our surgeons use the latest techniques to minimise the disruption of surgery and to accelerate your recovery.

If the lump is in front of the tendon then it can be treated simply by removing the spur. This is done either with a small incision alongside the attachment of the tendon or by keyhole surgery. The lump of bone is removed along with any inflamed area of the bursa. Sometimes the attachment of the tendon onto the bone is reinforced using a “suture anchor”, which is a strong plug used to strengthen the attachment of the tendon to the bone. 

If the tendon is growing into the bone then a slightly longer incision is used along the centre of the attachment of the tendon to allow the Achilles tendon to be removed. This way the bone spur can be fully exposed and completely removed. A very strong device called an Arthrex Speedbridge is used to securely reattach the tendon to the bone. This works with a figure of eight configuration of strong cord firmly attaching the tendon to the bone with four strong plastic plugs.

What happens after surgery?

You will usually be able to get home the same day or the day after. You would go home with your ankle either in cast or a moonboot. There will be some swelling and you will find it helpful to keep your foot elevated on a footstool in the early recovery period.

For treatment of spurs in front of the tendon where the tendon has not had to be removed, you would have a moonboot and can walk straight away. You would wear the moonboot for walking up to the four week mark to protect the tendon. 

If the tendon has had to be taken down and reattached, you would wear a cast for the first two weeks then a moonboot up to the six week mark. For the two weeks in cast you would need to use crutches or a knee walker to keep the weight off the foot.  During the following four weeks in the moonboot you would start with wedges under the heel to keep the foot pointing down. One of these is removed each week to allow the foot to come up to the neutral position and you start to bear weight. 

You would be seen in clinic at the two week mark to check the wounds. After coming out of the moonboot you would start physiotherapy. At that stage you can start to return to lower impact sports such as cycling, swimming and cross training. You can usually start to run by six weeks if the tendon has not been taken down and reattached or by about three months if it has.

Are there any risks?

All surgery carries risks, and Haglund spur surgery is no exception. The risks will be discussed with your treating surgeon and in particular whether you are at higher than normal risk. These include:

• Recurrence. Occasionally the spurs can reoccur.
• Tendon avulsion. Rarely, the tendon can pull off the bone after surgery and require reattachment.
• Infection. Minor infections are treated with antibiotics and wound dressings. More serious infections can necessitate hospital admission and surgery.
• Blood clots in the legs or lungs
• Ongoing pain
• Persistent swelling
• Numbness
• Nerve related pain