Haglund’s Debridement

(Retrocalcaneal Bursa Debridement, Insertional Achilles Tendon Debridement)

Indications for a Haglund’s Debridement

Some patients that have insertional Achilles tendonitis with retrocalcaneal bursitis and a Haglund’s deformity may benefit from surgical intervention including a Haglund’s debridement. This condition can usually be managed without surgery; however, there are some patients that continue to be symptomatic and will benefit from having a surgical debridement. A debridement is a “clean out” procedure designed to remove potential sources of discomfort (bone spurs, degenerated tendon, inflamed soft tissue). Surgical treatment is generally indicated when there is failure of several months of non-surgical treatment.

Procedures to Address an Insertional Achilles Tendonitis

Several different surgical approaches and techniques can be utilized in an operation designed to debride the Achilles tendonitis and excise the Haglund’s deformity. Commonly, this procedure is performed through an incision on the back part of the heel. This incision may be located on either side of the Achilles tendon, or directly over the tendon. In some instances, it may be possible to perform this surgery using minimally invasive techniques.

Debridement of the Achilles Tendon and Resection of the Haglund’s Deformity

Surgery to address an insertional Achilles tendonitis with a prominent Haglund’s deformity, and a retrocalcaneal bursitis usually involves three components: 1) removing the unhealthy degenerative portions of the Achilles tendon; 2) removing the inflamed retrocalcaneal bursa (fluid-filled sac) behind the Achilles; and 3) resecting the prominent bone (Haglund deformity) which puts abnormal pressure on the Achilles tendon. In some instances, there may be calcifications within the Achilles tendon that also need to be removed. Often, the attachment of the Achilles tendon to the heel bone (calcaneus) needs to be partially detached in order to removed the Haglund’s deformity. If the Achilles tendon is partially detached it must be reattached with sutures that attach directly into the bone. The goal of the surgery is to remove inflamed tissue, bone spurs, and degenerated tendon that has developed over the years.

Flexor Hallucis Longus Transfer to the Calcaneus

In older patients or those in which a large amount of the Achilles tendon is removed, one of the other tendons at the back of the ankle may need to be transferred to the heel bone to assist the Achilles tendon with strength. Typically, the flexor hallucis longus (FHL) tendon is used for this tendon transfer. The FHL tendon starts behind the ankle and runs to the big toe. It is one of the two tendons responsible for flexing the big toe downwards. Transferring this FHL tendon to help offload the Achilles tendon does weaken the big toe, but usually not enough for patients to notice.

Post-Operative Recovery following a Haglund’s Debridement

Initial recovery from this type of surgery involves protecting the surgical repair in a cast or a boot. This helps to allow healing of the surgical incision and the Achilles tendon repair. The surgeon will usually request that patient avoid weight-bearing on the affected extremity by using crutches or a walker. A range-of-motion program may be started once the incision has healed. Typically, after 4-6 weeks, a home exercise program and formal physical therapy program will be started. This therapy program will focus on progressive strengthening and stretching. If another tendon is transferred, recovery can take longer. This can be a frustrating condition, as many patients have some degree of pain and swelling even three to six months after surgery. However, things will usually improve so that by the time they are one year after surgery, most patients are doing noticeably better than they were prior to surgery.

Potential Complications

Specific complications that can occur with surgery that is performed on the back of the heel include:

Wound healing problems. Surgery on the back of the heel is associated with difficulty in wound healing. This occurs more often in certain patient populations (for example: smokers and diabetics). The initial period of immobilization ensures that your incision heals properly.
Rupture of the Achilles. This is a serious, but fortunately, an unusual complication. If too much of the Achilles is resected, this can weaken the Achilles and cause it to rupture following surgery. Although unlikely, if this does occur, it typically requires a return to the operating room to re-attach the Achilles to the heel bone.
Persistence of Symptoms. This is a “clean-up” procedure and it is not possible to replace all the scarred tissue with new healthy tissue, so some residual symptoms may persist.
Sural Nerve Injury. The sural nerve runs next to the Achilles and supplies sensation to the outside of the foot. This nerve can be stretched or irritated in the course of this surgery. This can lead to pain, burning, or numbness over the course of the sural nerve.

General complications include:

Edited on September 2nd, 2024

Previously Edited by Daniel Cuttica, DO and Matthew Buchanan, MD

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