Haglund's Deformity

For over a decade I’ve been suffering from Haglund’s Deformity. This a condition where the heel bone grows abnormally and causes painful pressure on the Achilles Tendon. About 12 years ago I was doing a lot of hiking, which aggravated my heels. I went to a general practitioner who X-rayed my foot but saw nothing and said not to come back until I lost weight.

Now forward the clock a dozen years and I live in a new city, a new state, and have a new doctor. I’ve finally taken weight loss seriously and added regular exercise. But my exercise attempts are making the heel pain excruciating. Despite dramatic weight loss it did not help my foot pain at all, and in fact made it much, much worse. Even shopping in a store with hard floors had repercussions. And if I had to do any extended walking on pavement or concrete the effects would last for days. Vacationing with my family at an amusement park was a serious challenge because of all the walking required. Eventually, even the act of walking from my vehicle to my desk at work became a mental discipline of pushing through the pain and making myself put one foot in front of the other.

Note the three sharp protrusions on my heel.

When I saw my general practitioner about the pain, the doctor directed me to seek a diagnosis from an orthopedic specialist. And this time I got properly diagnosed: even I could see the problems in the X-rays. The reason it felt like I walking on sharp spikes in my feet was because I did! In addition to bone spurs I had stage 3 Haglund’s Deformity in my right foot. (“Posterior calcaneal exostosis” in medical terminology.)

My orthopedist recommended non-surgical remedies first, starting with physical therapy. Instead of improving, it makes things worse and after a month-and-a-half was discontinued. I did incorporate some of the therapy exercises, those that didn’t aggravate my condition, into my own exercise routines. My primary exercise through the summer had been swimming since it did not create an impact on my heels. I used the body-weight exercises when the pool was closed due to weather or maintenance and when travelling to locations without a pool. My equipment for body-weight exercising was minimal and could be brought along on trips: a thick yoga mat, three-pound ankle weights, a stretching strap, a resistance band (highest level), and a foam roller.

Other therapy attempted was a night splint and it was sheer torture and quickly abandoned. I was also prescribed an Achilles Brace and orthotic wedges. They didn’t lead to a noticeable improvement, but since they did not aggravate my condition they were continued throughout the process. A cortisone injection was administered during my initial visit, but the benefit was extremely short so there were no additional injections. Icing and a topical anti-inflammatory cream were also of only temporary relief but were continued since I had already purchased them.

Ahhh … finally some relief

Ahhh … finally some relief

In the second month, of our search for relief, the orthopedist prescribed a boot brace with a large orthotic wedge (holding the toe pointed down, i.e., relaxing the Achilles Tendon). It alleviated the pain tremendously and significantly helped my mobility. So for the next half-year I happily wore the boot because of the relief it offered. It also allowed me to stay active, which helped with my weight loss efforts.

About a week after getting the boot a follow-up MRI clarified the diagnosis and showed that the Haglund’s Deformity has ruptured my Achilles Tendon. And it also identifies the existence of fluid buildup (i.e., bursa) and other tendon damage. So the next attempted resolution was a PRP (platelet rich plasma) injection. After the Christmas holidays I came into the orthopedist and they extracted and enriched my own blood before injecting it into the damaged site to trigger healing. The big restriction during the two-month healing period that followed, was a complete prohibition of caffeine! Thankfully, I’d already begun to wean myself off of caffeine beforehand to improve my sleep and general wellness. So it wasn’t as traumatic as it could have been! I used to take in huge amounts of caffeine in the form of free Diet Mountain Dew from the company break room. With my favorite and highly-caffeinated drink always at hand I was easily drinking a gallon a day! The withdrawal symptoms could have been a lot worse. The other instructions for the healing period was to dramatically increase my vitamin C intake, which was a simple as taking a couple of gummies daily. And I had to eliminate impacts to the area, which meant I could only walk short “normal” distances (and that with the boot). Anything longer and I used the wheelchair. Since swimming didn’t cause impacts, I could continue that and my aqua aerobic classes (it was winter and I’d switched to an indoor community pool).

After eight weeks of being in a boot and/or wheelchair the PRP provided no discernible improvement. Sometimes a single injection is successful. For other patients the first short takes them most of the way, and a follow-up injection is needed to get them across the finish line. But in about 30% of the cases there’s no effect, which happened to be my predicament. PRP was a gamble (and a financially expensive one since not covered by insurance at all), but we all agreed it was worth the chance to avoid surgery.

By now, seven months had transpired. And the surgery, that I sensed from the beginning would be necessary, was finally going to happen. By this point my boot has seen so much mileage that it was severely worn and some of the straps were at the breaking point (literally holding on by mere threads). So, I purchased a replacement from Amazon since I would need a boot for an additional two months after surgery. And also because it would be better to use a new, clean boot on a freshly operated-on foot for health reasons.

After the surgery decision it was a couple of weeks of waiting, in which they scheduled my operation and had me prepare for the event. I’ve written about the surgery in a follow-up article, so I’ll close this one with a summary of the pre-op. The week before my operation, I suspended all dietary supplements and vitamins. I specifically had to avoid all anti-inflammatory creams or pills. And for the three days prior to the surgery I bathed with a special antibacterial soap and had to swab the inside of my nostrils with a antibiotic gel. And, as with most surgeries, starting on the previous midnight there was no intake of any food or water. In light of that, for my last pre-surgery meal we went out to eat and had a hearty supper.