Dr. Patrick DeHeer, DPM - Haglund's Deformity Reduction Part 1 of 2

[bombtreez]

Also which Doctor do u recommend in Florida for this surgery?

[bombtreez]

Hey doc how much does this surgery cost?? I just need a ballpark price! I'm scared I can't afford it but I'm in a lot of pain!

[mamiasmamias]

..continue

the dr said to me that if the haglund bone donot reshape after 5years probably is going to stay as it is

the extra trouble i mention at the first paragraph is that if we detach the tendon is going to be a very long healing procces and i can run again and play soccer after a year or more...but with no detachment of the tendon in 3 months

i want your opinion for the things i wrote you

thank you very much

[mamiasmamias]

continue..

i had the same surgery at the other foot 5 years ago,and my foot is in good contition

the remaining bumb hurts a little(when i'm barefoot,after soccer practice)but this is nothing compares the pain i had before surgery

i had xray the 5year foot so the dr can see if there is re occurance,and it is a very little bit,away from the tendon yet but the dr said me thats probably because of the healing procces of the bone after the surgery ........

[mamiasmamias]

hello doctor i am john and i'm 38 years old

first of all you have to excuse my english

a month ago i have had surgery to remove my haglunds deformity,only the deformity without detachment of the achilles tendon

from the outside of my heel there still is the bumb(there is a calcification at the insertion of the tendon) ,the dr said that the tendon is inside it and the only way to get rid of the bumb is to detach the tendon but this is going to cause me extra trouble

[peplajso]

i have bursitis in my achilles,it is red and causes pain in my achilles for weeks after using a heel lift,ice,anti-inflammatory medication,cortisone injections..i have a bump on the back of my heel,what would you recommed for me to do please??if the bursa was removed,will it grow back naturaly then?what if i got my heel bone re-shaped, willthe bone grow back? /it would make more pressure on bursa again... then, would i have to undergo the same surgery again or what?

[padeheer]

@peplajso First, stretching is important no matter what other form of treatment you have. Use a night splint, it takes about 3 months. I would try shockwave therapy before any open procedure. I use the EPAT machine and it works very well. No risk, no down time, just small chance it may not work. Best Wishes.

Dr. Patrick A. DeHeer, DPM

[peplajso]

@padeheer Doctor, I have had this problem for about 8 months now. Couple of weeks ago it was recommended to me to try the RTG therapy, so I did that as well. I am afraid of trying any further therapy, because I tried laser, injections, RTG, so do you think using the EPAT machine would be safe? Also, I spoke to my doctor here and he said he would have to make a longitudinal cut on my Achilles in order to reshape the heel bone once the bursa is removed..For me as a basketball player, do you...

[staefe77]

I am having a problem like this with my foot, my doctor is saying that he will need to cut at the insertion to clean up the problem, and also cut the tendon up in my gastrocnemius to extend the tendon because it is tight. Is it possible to just do the insertion point and work on flexibility after the surgery? I just want to be able to run again with out any pain.

[padeheer]

@staefe77 That is a very common approach and nothing out of the ordinary. Tightness of the calf muscle is the underlying cause of the heel problem. Best wishes.

Dr. Patrick A. DeHeer, DPM

[cowboys430isback]

if there's no blood flow, wouldn't the feet cells die?

[padeheer]

@cowboys430isback The longest we can leave a torniquet on is for 2 hours before allowing blood flow back to the foot. Best Wishes.

Dr, Patrick A. DeHeer, DPM

[Mia15262]

Why the hell is there no blood??

[padeheer]

@Mia15262 I use a tourniquet during surgery which eliminates the blood flow. Best wishes.

Dr. Patrick A. DeHeer, DPM

[JoeSupermoto]

I am due to have this op on both heels, my bone spurs appear to be a lot worse than one in the video. How long is recovery time? How long before I can walk distances again?

many thanks Sir.

Joe

[padeheer]

@JoeSupermoto I only do one foot at a time. It usually takes 10-12 weeks to heal fully. Then you can ease back into a walking program. Best wishes.

Dr. Patrick A. DeHeer, DPM

[JPSovereignStrikes]

is that local anesthetic? or is the patient out? how long is the surgery?

[padeheer]

@JPSovereignStrikes It is a general anesthetic, normally the procedure takes about one hour. Best wishes.

Dr. Patrick A. DeHeer, DPM

[UomoUniversum]

I had this surgery 3 Month ago...I am so happy, no pain anymore, I can run, bike and kickbox as before,

[padeheer]

@UomoUniversum It usually provides very consistent results. I am glad to hear you have had a good outcome. Best wishes.

Dr. Patrick A. DeHeer, DPM

[dwbarcl]

I am going to have to have this surgery soon on both feet. My Doctor said he can do one and then 2 months later the other. Does this sound possible? Also he is using the Achillon® - Achilles Tendon Suture System where you use the Mitek. Is there that big a difference in them? Thanks

[padeheer]

@dwbarcl Yes that plan sounds very doable. The suture system you speak of is what I do most of the time now. The key is the post operative course. Best wishes.

Dr. Patrick A. DeHeer, DPM

[jad0900]

Hello Doctor. I have some simple questions: How can you just take out the bursa? Isn't it a necessary sac? Will it grow back? Why can those bone shavings (the small ones) be left inside the patient? They won't get into the bloodstream and clog something? Last question: Why and how is there no blood?

I haven't seen a surgery before. Could you feed my curiosity? =)

[padeheer]

@jad0900 The bursa becomes a problem and removing it does not cause any problems. The surgical site is flushed out with sterile water prior to closure. There is no blood because we use a tourniquet to stop blood flow to the leg during the surgery. Best wishes.

Dr. Patrick A. DeHeer, DPM

[KhalidSM]

Hi

I am suffering from Hugland deformity on my both heels since years , left is much worse than right. Initially the pain was manageable I was even regularly playing tennis Since last 3 months pain has flair up to the level that I can't walk without limping despite taking pain killer. I can't go through regular recovery period due to work needs, I heard about MIS technique which requires 3 days rest and you could go back to normal activities, any idea about a good Surgeon in LA, CA area?

[padeheer]

@KhalidSM I would suggest Dr. Jim Wang, he is excellent. I am not sure how he treats this condition. Shockwave therapy may be an option. Look for EPAT therapy in your area. It may be an option for you, there is no down time at all with it. I hope this helps. Best wishes.

Dr. Patrick A. DeHeer, DPM

[KhalidSM]

@padeheer

Hi Dr. DeHeer

Thanks for getting back to me. I will make an appointment with Dr. Wang; I would also look into EPAT therapy. Said that due to employment reasons I am currently in Dallas area and only go back to California once every couple of weeks. For that reason I have made an appointment with Dr. S. Chaim MD of Plano Orthopedic Sports medicine, have you heard about that place before? Last but not least; In the end have your heard about Dr. Nunez an expert in MIS to correct Haglund

[padeheer]

@KhalidSM I have not heard of either one of this doctors. I have done Haglund's deformity with an arthroscopic approach in the past. I still think an open approach is much more reliable, as you are able to adequately resect the boney enlargement. This is the key to the whole procedure. Hope this helps. Best wishes.

Dr. Patrick A. DeHeer, DPM

[7s7k]

My doctor has confirmed, calcaneal spurs on my both heels and recommending to undergo surgery  both heels at the same time. Is it recommended to undergo surgery for both heels at the same time and pls advice me on the recovery length and process will be.

[padeheer]

@7s7k I would not recommend doing both feet at the same  time. Do one foot, let it heal completely and then do the second one. Your outcome will be much more predicable. It normally takes 6-8 weeks of immobilization depending on how much tendon is reflected. You can count on it being achy for another 2-3 months after that. Best wishes.

Dr. Patrick A. DeHeer, DPM

[7s7k]

@padeheer Hi Dr, im a soccer player, will i be able to be play soccer as normal after my surgery and will my tendon will be strong as before? is the any chance the spurs might recur back.

[padeheer]

@7s7k Yes you can return to normal activities with adequate healing. Recurrence is always a possibility, but adequate resection of the deformity is key. I hope this helps, best wishes.

Dr. Patrick A. DeHeer, DPM

[poorfamily]

Thanks for posting this video! I had the surgery done 3 weeks ago. My doctor did very little explaining as to the details so your video was very helpful. In my case I think he totally separated the tendon due to the large size of the spur. Two anchors used to reattach and non-weight bearing for six weeks (crutches and boot) then therapy for 4 weeks. Sleeping in the boot is sometimes rough but very little pain and the foot feels stronger every day. I suffered as a mailman for 8 months walking :)

[padeheer]

@poorfamily You are welcome, best wishes for your recovery. It sounds as if you may have had a retrocalcaneal heel spur with a Haglund's deformity.

Patrick A. DeHeer, DPM

[alamoalan1]

i am due to get this spur removed but it is supposed to be 20mm long and is also broken at the top is this common and will it do any damage until i am waiting for surgery

[padeheer]

@alamoalan1 No, that will not change the procedure or the outcome. Sometimes the tendon can become thinned where it attaches into the heel. If this happens, you have to lengthen the tendon to pull down healthy tendon to attach to the heel. Hope this helps.

Patrick A. DeHeer, DPM

[stogsville]

HI I am going to have this done in the uk next month but I dont think they are doing the tendon is it nessacerary. I am just having bone lump removed.

[padeheer]

@stogsville Typically, you have to reflect the achilles tendon sometime depending upon the size of the deformity. The most common mistake is to not take enough of the bone off to correct the deformity. Often times, I use one soft tissue anchor to reattach the tendon. Hope this helps. Best wishes.

Patrick A. DeHeer, DPM

[lisaann7451]

Now I am a month post surgery. Is it normal to fell as if my tendon is going to tear. It feels really tight as if it is stretched to the limit and this is when my foot is flat on the floor. Stretching makes it worse.

[padeheer]

@lisaann7451 You are very early in the healing process, do not get too worried this soon.  Just follow you post-operative instructions and you should do well.

Patrick A. DeHeer, DPM

[SumWhereMeBelongs]

im supposed to have this done in a few weeks

and after watching this im only more terrified

from what people say the recovery is long painful and uncomfortable

im doing my a levels this year and i dont think its worth the pain

id rather just wear trainers and bare with it o_O

[padeheer]

@SumWhereMeBelongs This procedure is very predictable, if you follow post operative instructions you should be fine. Best wishes.

Patrick A. DeHeer, DPM

[lisaann7451]

Thanks Dr. Padeheer, you are the greatest. I wish you were here in Milwaukee, WI.

[padeheer]

@lisaann7451 Thank you very much.

Patrick A. DeHeer, DPM

[lisaann7451]

Ok, I had the surgery. Recovery is not so nice, but I am hanging in there. It has now been 3 weeks and I still have a lot of soreness and swelling. If I stay off of my foot it is fine. But if I walk up and down the stairs, it starts to swell and throb.

[padeheer]

@lisaann7451 You sound as if you are on track. Hang in there, look for slow steady improvement. Best wishes.

Patrick A. DeHeer, DPM

[odanak100]

I def. have this

[lisaann7451]

Hi it's me again. I am experiencing some burning sensation on the top part of my right foot ( the same foot as the haglund's) it feels as if a hole is there or something is missing. It hurts really bad when I drive and walk. Should I contact my MD right away? Oh and also, my ortho doc is using a scope. Does the bone always have to shaved down, or can the area just be cleaned out?

[padeheer]

@lisaann7451 The bone does need to be removed, but it can be done with a scope. It is more work for the doctor but should result in quicker healing for you. The pain in the top part of the foot may be from compensation. You should have it checked if it continues. Best wishes.

Patrick A. DeHeer, DPM

[lisaann7451]

Hi it's me again. I am experiencing some burning sensation on the top part of my right foot ( the same foot as the haglund's) it feels as if a hole is there or something is missing. It hurts really bad when I drive and walk. Should I contact my MD right away?

[wrathall11]

A year ago I had my right foot done and on Thursday i get the left one done. This is a real painful condition and I cant wait for my feet to be back to normal, I also had the achilles lengthend, but have to say recovery is very slow. Its taken me a year to be ok so that the other foot can be done. I do battle with my calf muscles though. I wonder if this condition will return though, as I wil not go through this again

[padeheer]

@wrathall11 The amount of time it takes to develop makes it very unlikely to come back. Also, by lengthening the achilles tendon you significantly decrease the recurrence rates also. Best wishes.

Patrick A. DeHeer, DPM

[jjpharissTheReal1]

@padeheer oh my leg when i do something idk what but on side of me foot it has 3 bones sticking out ? hwy is that and how cause it hurts and i cant move it when it happens

[memevialino]

@padeheer Had this same operation done 6 years ago on both feet (at the same time). Very similar procedure, except for the incision: horizontal instead of vertical. Unfortunately in my case the Haglund's deformities grew again a year later. I am pretty sure I had my achilles lengthened at the time. Recovery process was painful and lengthy; would not recommend having them removed on both feet at the same time. Underwent experimental treatment to numb area. Thank you Dr for sharing this!

[padeheer]

@memevialino You are welcome. Best wishes.

Patrick A. DeHeer, DPM

[yourcarpenter1164]

@memevialino How are you doing now?

[jsmithsar]

So after the surgery you can be partially walking with the boot on after 2 weeks or so?

My surgeon is stating 8 weeks total,,before I walk on the boot. I will be careful,,just worried if I happen to put both feet down at the same time, say 5 weeks into it, the Achilles will shear off and now I am back to square one. Yes, no maybe?

[jsmithsar]

So after the surgery you can be partially walking with the boot on after 2 weeks or so?

My surgeon is stating 8 weeks total,,before I walk on the boot. I will be careful,,just worried if I happen to put both feet down at the same time, say 5 weeks into it, the Achilles will shear off and now I am back to square one. Yes, no maybe?

[padeheer]

@jsmithsar No that would be highly unlikely to happen that far out.  I use non-weight bearing for 2 weeks and full weight bearing with a boot for 4 more weeks after that. If you have a spur on the back of the heel and have to completely detach the achilles tendon then it is more like you are describing for healing. Best wishes.

Patrick A. DeHeer, DPM

[jsmithsar]

@padeheer Dear Dr, yes my calcification was immense, he had to detach the tedon completely.

So then 6 weeks non weight bearing, is the danger timeframe, if I have to come down on my foot in case of an emergency?

[lisaann7451]

I am going to have this surgery in two weeks. What is the normal recovery time?

[padeheer]

@lisaann7451 Normally about 6-8 weeks. I have patients non-weight bearing for two weeks and partial weight bearing for 4-6 weeks in a walking boot.

Patrick A. DeHeer, DPM

[misstheobx]

@padeheer What is the cost of having the surgery done?

[misstheobx]

what is the cost of this surgery. i don't have insurance.

[llenoj56]

I just had this surgery this past Friday. However, I was just given a post-op shoe, and told that I would be weight bearing right away. I have been having a lot of pain with walking, so am not able to bear full weight yet. I am confused, as everywhere I look, the post-op recommendation is a boot/cast and non-weight bearing status.

[padeheer]

@llenoj56 I would have you non-weight bearing for 2 weeks with crutches in a cast boot. Then you would be able to walk in the boot for 4 weeks. I think this takes about 6 weeks to fully heal. Best wishes.

Patrick A. DeHeer , DPM

[tiagofbb]

Hi Mr. DeHeer; first I would like to say that you did a good job. I wanted to know more about this pathology and I have some questions if you can help me:

1- What is the differential diagnosis among Haglund's deformity and posterior exostosis of the calcaneum??

2- The surgical treatment is it the best??

3- When the surgery is it necessary??

Thx for your attention and sorry my bad english.

Have a nice week and success always!!

Best Regards

Tiago

[padeheer]

@tiagofbb 1. Haglund's, achilles tendonitis, bursitis, retrocalcaneal heel spur.

2. Yes, the surgery is the best treatment if all conservative therapy fails. The surgery has very good, consistent results.

3. See above.

Best wishes.

Patrick A. DeHeer, DPM

[originalitchybag]

I had my achilles re attached 6 years ago after I snapped it playing rugby. I now have this bump at the achilles insertion point and was wondering if I were to get this surgery how it would affect me in the future since Ive already had my achilles worked on. Its just started to hurt and if I take it easy the pain goes away and only returns when I run or stand for extended periods of time.

[padeheer]

@originalitchybag I would recommend a night splint to stretch the achilles, oral steroids, orthotics to treat this initially. Doing a revision surgery would be very difficult. I would try platelet rich plasma injections before that if I was treating you. It is low risk with potential high reward.

Patrick A. DeHeer, DPM

[4841253]

How long does the surgery usually take? Are you out the whole time?

[heftybuttocks]

Hi again and thank you for your reply.

Just had an examination by a Podiatrist. She said it is Haglunds with Hellbings curvature of the tendon. As there is no constant pain and this being the UK NHS, she advised physiotherapy consisting of 20 foot push ups twice a day to strengthen the tendon. I'm not convinced that's a long term solution, but I will give it a go.

[padeheer]

@heftybuttocks Stretching is very important also, the runner's stretch is a good one. Best wishes.

Patrick A. DeHeer, DPM

[heftybuttocks]

I am a 54 , male and have had a pronounced bump on both L & R heels for at least 25 years. I have gone from shoe size 9 to 10 to accommodate the protrusions. I have a fairly high in-step. I have only had pain for the last 18 months or so in the achilles tendon area and not the bump, but it is now so bad I need treatment. Other similar videos I have seen do not show the use of an anchor, is an anchor always used in this surgery. Is there much pain after surgery and if so for how long?

[padeheer]

@heftybuttocks Yes you need to reattach the tendon some way, most will use 2 or 3 anchors to do so. The post-op pain is not too bad, it just takes a long time to heal from. If you give it the proper healing time, you will do well. Best wishes.

Patrick A. DeHeer, DPM

[breanerox]

I don't know if i have this. I have the bump and it's hard, but it doesn't hurt. I'm a figure skater and would that have something to do with the bump?

[padeheer]

@breanerox Yes is could due to the heel counter that is on skates. If you have a higher arched foot, you will be more prone to this. If it does not hurt, there is no reason to do anything until it does. Best wishes.

Patrick A. DeHeer, DPM

[Ms11Wendy]

HOw long must one be in a cast or crutches?

What types of shoes are to be worn after being in crutches? Are there special sandals that can be worn because I am getting it done during summer and I can't stand being in closed shoes the whole time.

[padeheer]

@Ms11Wendy With a Haglund's I have patients non-weight bearing for 2 weeks followed by a walking cast boot for 4 weeks. There are no restriction once the area is healed regarding shoes. Initially, open-backed shoes will be more comfortable for you. Best wishes.

Patrick A. DeHeer, DPM

[phus2001]

I just had this surgery on my right foot. about 7 years ago I had it on my left foot. I am still not sure what really causes this problem, I think it has to do much with the mechanics of the foot. I wish I had done the surgery immediately, the conservative treatment does not work

[Rigel801]

Very interesting Doc. Thanks for posting! A few questions for you:

How long do you need to be out of work? (I sit at a desk, nothing too active)

Will this definitely get rid of the pain? (I've been told by some that it's not a sure thing)

Can conservative treatment for this (heel lifts, etc.) actually be effective? Nothing has worked so far. I'm only 24 and I don't want to deal with this problem forever!

Wish I could have you do my surgery Doctor. It really looks like you're a pro.

[padeheer]

@Rigel801 You could go back to work after 2-3 days if you are at a desk. If this is the problem, this takes care of it. The biggest issue afterwards is some achilles tendonitis which usually resolves without too much difficulty. Conservative care is very unpredictable with this condition. Thank you I have been doing this for a long time, I had great teachers who gave me a lot of experience. Best wishes.

Patrick A. DeHeer, DPM

[Ms11Wendy]

are you put to sleep during the surgery

[padeheer]

Yes a general anesthesia to put you completely to sleep.

Patrick A. DeHeer, DPM

[Nelly449]

it looks like complete tendon rupture but i think its only on the lateral side

[padeheer]

You have to free up the lateral side to expose the bone, then you reattach the tendon with an anchor.

Patrick A DeHeer, DPM

[heat1450]

Hello. I have had pain in my achilles bursa sac for about two years. I have alraedy had physical therapy. After the therapy my ankle felt good, but three soccer practices later the pain was back. What would your recomidation be? A steroid injection or surgery like this video?

[padeheer]

Thank you for your kind comments.

[malquaimi]

I am really impressed by the procedure and by the elegance of the surgeon.thank you for sharing it with us.

[padeheer]

It takes about 10 weeks before you can run again, you must let the tendon heal. The success rates are very high usually for this procedure. Best wishes.

[donnyh9166]

Thank you for this post I just had this procedure done and want to know your how long do you think till the patient is 100% mobility again (running)? Also what is the success rate that the patient won't experience the same pain before the surgery? Thank You

[Ms11Wendy]

@donnyh9166 were you put asleep during this surgery? I am going to have it done I am sooo scared