Treatment
Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the bursitis, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:
- Removal of the problem: Walking without shoes takes the pressure completely off the affected area.
- Medication. Anti-inflammatory medications may help reduce the pain and inflammation. Some patients also find that a topical pain reliever, which is applied directly to the inflamed area, is beneficial.
- Ice. To reduce swelling, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.
- Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel.
- Heel pads. Placing pads inside the shoe cushions the heel and may help reduce irritation when walking.
- Shoe modification. Wearing shoes that are backless or have soft backs will avoid or minimize irritation.
- Physical therapy. Inflammation is sometimes reduced with certain forms of physical therapy, such as ultrasound therapy.
- Orthotic devices. These custom arch supports are helpful because they control the motion in the foot, which can aggravate symptoms.
- Immobilization. In some cases, casting may be necessary to reduce symptoms.
If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. surgical treatment: Debridement of affected tendon and excision of retrocalcaneal bursa and haglund deformity. A central approach facilitates such debridement but necessitates detachment of 50% of the tendo achilies from calcaneus which is usually sutered back using bone anchors. In severe cases after debridement of substatial portion of the tendo achilies, augmentation may be done with the transfer of the flexor hallusis longus muscle.
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