Haglund's Deformity. Again.

[slcbelle]

As I posted last year, the Jackson Premiere's were giving me Haglund's deformity so I stopped skating and bought a pair of Riedell 375 Gold Stars.  They felt great at the shop but 5 minutes on the ice and I was dying.  After some tweaking by my ski boot fitter (who has cool hydraulic punches, a convection oven, and made me custom orthotics), I got back on the ice.  They were so much better.  At first.  Now that I am skating 4 or 5 days a week and learning the sit spin, I'm in big trouble and lots of pain.  Haglund's is back with a vengeance and it kills! I spoke with my coach and others about custom boots but I know a lot of people who struggle just as much with their customs as I am with this stock boot.  I just bought the Bunga Achilles sleeve today and still limped off the ice.

Any thoughts or advice?

[AgnesNitt]

Have you thought or tried putting a donut around it? You could make one out of a cosmetic sponge (or two) to see how that works to relieve the pressure. I use the one from skating safe made out of some kind of gel around my ankle. It's indestructible but probably too big for your heel. You could make one out of the thin gel sheets if a donut works for you.  And for what it's worth, I read that icing it helps. I've found icing my hip with bursitis before and after I skate has been helpful. Since HD is associated with bursitis, it might work there too.

[Landing~Lutzes]

I had a similar situation, tried everything. The only thing that helped (you're not gonna like hearing this  ) was having custom Harlicks made... Best decision I've ever made! I spent around $1100 total for boots and blades, but to me, it was worth it. heck, I've spent almost as much bouncing around from stock boot to stock book! One thing that has helped me a small bit in stock boots is Moleskin. I also use it in my pointe shoes. You can get it at REI or any sporting goods store, and I'm sure WalMart or any drug store may sell it in the BandAid isle. Also, I use this when I wear heels and other shoes exposed to my bare skin: BandAid Anti-Friction Block. I got it at WalMart in the BandAid isle for around $5. It's just a little mini deodorant-type stick that you rub where your shoes (or skates) rub, and it is supposed to stop the friction. Works well for me in shoes but have not tried it in skates. I found out about this little guy after I got my Harlicks.

[slcbelle]

Have you thought or tried putting a donut around it? You could make one out of a cosmetic sponge (or two) to see how that works to relieve the pressure. I use the one from skating safe made out of some kind of gel around my ankle. It's indestructible but probably too big for your heel. You could make one out of the thin gel sheets if a donut works for you.  And for what it's worth, I read that icing it helps. I've found icing my hip with bursitis before and after I skate has been helpful. Since HD is associated with bursitis, it might work there too.

Hey Agnes!  Thanks for the input.  I've tried moleskin and donuts.  They tend to get rubbed off and leave a sticky residue which makes the friction worse or scoot away from the original position.  But, icing is a great thing.  I just started icing today - three times already - and I'm popping the Advil in hopes of reducing the swelling.  I have another hour long choreography session tomorrow.

I had a similar situation, tried everything. The only thing that helped (you're not gonna like hearing this  ) was having custom Harlicks made... Best decision I've ever made! I spent around $1100 total for boots and blades, but to me, it was worth it. heck, I've spent almost as much bouncing around from stock boot to stock book! One thing that has helped me a small bit in stock boots is Moleskin. I also use it in my pointe shoes. You can get it at REI or any sporting goods store, and I'm sure WalMart or any drug store may sell it in the BandAid isle. Also, I use this when I wear heels and other shoes exposed to my bare skin: BandAid Anti-Friction Block. I got it at WalMart in the BandAid isle for around $5. It's just a little mini deodorant-type stick that you rub where your shoes (or skates) rub, and it is supposed to stop the friction. Works well for me in shoes but have not tried it in skates. I found out about this little guy after I got my Harlicks.

That's exactly where I think I'm headed, Lutzes!  I spent the past 4 weeks in the Bay Area and had an appointment to go to Harlick last Friday (only 45 minutes from where I was staying) and then my dog got very sick and we had to hospitalize him in Berkeley!  I had to cancel my appointment and now I'm back in Utah.  Fortunately, I'll be back in the Bay Area several times over the summer and will reschedule.  I'm thinking it's the only way to go at this point.  If that fails, I'll have to quit.  Deformity is not part of the fun, ya know?

[sarahspins]

I think this has everything to do with the shape of the heel counter - boots that fit well will "hug" your ankle above where the achilles attaches to your heel help lock your foot in place in your boot, all of the pressure should be on soft tissues and you really shouldn't get any pressure on any part of your heel.  Two years ago I tried to break in a pair of SP Teri's and I had to stop because of pressure on my heels, right where you've developed your haglund's deformity... it wasn't overtly painful, just uncomfortable, but I didn't want to chance it developing into something much worse so I stopped trying to wear them.  I had previously worn SP Teri's without any problem, so I was surprised that they just weren't going to work.

I would personally suspect that there are two things at play for you - while the fit of your current boots is much better than with your previous Jacksons, it's still not as good as it could be.. I think your heels are probably still slipping inside your boot which is creating pressure where there shouldn't be any.  Second is that the shape of the heel counter in your boots might not fit well with the shape of your heels.

Custom boots won't guarantee you get boots without problems but they can take into account the shape of your heel and hopefully shape the counter better to work with your foot.. I would definitely suggest making another appointment with Harlick to talk to them.  Second to that though I'd go see a doctor, anti inflammatories or even steroid injections may temporarily help.

[slcbelle]

Thanks, Sarah.

A friend found these online:  http://www.amazon.com/Elite-Hockey-Achilles-Heel-Gel/dp/B0087TY85Y/ref=sr_1_1?ie=UTF8&qid=1369883301&sr=8-1&keywords=Elite+Achilles+Heel  and I saw this http://www.amazon.com/Elite-Hockey-Achilles-Heel-Gel/dp/B0087TY85Y/ref=sr_1_1?ie=UTF8&qid=1369883301&sr=8-1&keywords=Elite+Achilles+Heel.  I think both are temporary fixes to a much bigger problem.

[aussieskater]

So sorry you're having such problems.  I agree with Sarah that it's most likely a fit issue, in that there's a mismatch between the shape of the heel counter and your heel.  I'd strongly recommend that you visit a podiatrist or similar, before the injury gets worse or you put down $1,100 on custom boots.  Anything you do now would be a temporary fix, until you've had professional medical help.  We only get one set of feet and they have to last a while!

I'd be concerned about the achilles pad you linked to - won't that just increase pressure on your heel and make the problem worse?  Seems to me that a donut would work better to distribute the pressure away from the area of injury?  Maybe as a temporary measure, and if the achilles pad you've linked isn't too thick to do it, you could cut a hole out of the achilles pad to make it a donut or half-donut to fit around the injury.  Really make sure you properly angle and grade the cut edges, so there's a smooth graduation from skin to full-thickness pad.  Wearing the pad next to your skin (inside your tights) might hold it somewhat better in place?  A pad in the heel will tend to push your foot ever so slightly forward, so there would need to be sufficient extra length in your boot to accommodate it.

Best of luck; I hope you can get this issue fixed without further pain or injury.

[jjane45]

so sorry the situation has gotten worse for you.

punching the skates fixed it for me. the hump is still there but it has not hurt ever since.

[slcbelle]

So sorry you're having such problems.  I agree with Sarah that it's most likely a fit issue, in that there's a mismatch between the shape of the heel counter and your heel.  I'd strongly recommend that you visit a podiatrist or similar, before the injury gets worse or you put down $1,100 on custom boots.  Anything you do now would be a temporary fix, until you've had professional medical help.  We only get one set of feet and they have to last a while!

You are so right.  I just emailed my sports med doc for a recommendation of a sports podiatrist.  I've been thinking of this and your suggestion confirmed that I need to see someone before going any further.  Thank you.

punching the skates fixed it for me. the hump is still there but it has not hurt ever since.

I had the back punched a little but I am cautious about doing too much.  I don't want there to be so much room that the problem is worse.  I have an appointment with my boot guy but I'll see a foot doc first and confirm with him.  I'm so glad you are doing better!

[Neverdull44]

I am 44, an adult skater returning from the 1970's.  I have Haglund's deformity.  It comes & goes.  It is most painful when I try to walk in skating boots.

When I was 13, I got a Bauer Bump/Haglund deformity.  I stopped skating (teenager), and it went away (or at least became less noticeable).

Then, I went back to skating hard in my 20s.  I had very bad Haglund's, skating on Riedells.  I went to see a podiatrist, and took in my boots.  He injected cortisone and then put a pad inside my boot.  It wasn't on the heel, but in another spot.  It cured the problem and the deformity went away....  I skated for several years after that, with no issues in those boots.

Now, after 2 kids, I got back into skating in my 40s.  Bought custom Harlicks (feet grew a size).  But, I recently put a pad in the arch because my arches cramped up when I was in on-ice warming up.  Within 2 weeks of modifying my Harlicks, I have a Haglundh's bump forming.  I took out the arch pad on that side.  It didn't hurt skating yesterday or the day before.  Just a tad painful when I stroke, and tad painful to walk in the boots.  But, the bump is huge this morning.  Have to make an appointment to see the podiatrist.  I suggest anyone with this go immediately to see a podiatrist. 

I will do more Yoga.  It helps too.  Downward dog is a great stretch for the Achilles tendon and my plantar fascitis.

When you decide to be a figure skater, you make a deal with the Devil.  "Devil, if you make me a beautiful skater, I will sacrifice my (hips, knees, ankles, feet) at some point during my journey."

[slcbelle]

When you decide to be a figure skater, you make a deal with the Devil.  "Devil, if you make me a beautiful skater, I will sacrifice my (hips, knees, ankles, feet) at some point during my journey."

   Yikes!  Thanks for sharing your story.  I'm 41.  I spoke with two of my sports orthopedists for a referral and it seems that orthopedists don't really respect podiatrists.  They'd rather I see an orthopedist who specializes in feet.  Hmm.  What to do?  I have one more call into my primary care for a referral.  I don't know too many other people in SLC with foot issues so I'm starting the search from scratch. I'm DEFINITELY seeing someone.  If I can get these boots to work, as you did in your 20s, that would be awesome!

Keep in touch with me and let me know your progress.  I'm interested and concerned for you. 

[twokidsskatemom]

  Yikes!  Thanks for sharing your story.  I'm 41.  I spoke with two of my sports orthopedists for a referral and it seems that orthopedists don't really respect podiatrists.  They'd rather I see an orthopedist who specializes in feet.  Hmm.  What to do?  I have one more call into my primary care for a referral.  I don't know too many other people in SLC with foot issues so I'm starting the search from scratch. I'm DEFINITELY seeing someone.  If I can get these boots to work, as you did in your 20s, that would be awesome!

Keep in touch with me and let me know your progress.  I'm interested and concerned for you.

have  you talked to L yet about who to go to? I know she has a list.

[slcbelle]

have  you talked to L yet about who to go to? I know she has a list.

No, I haven't.  We've been talking about my boot issues forever but she hasn't recommended that I see a podiatrist.  I'll ping her.  Thanks!

[Neverdull44]

Orthopedic doctor or podiatrist, which to choose?

Back in the 90s, when I had Haglund's Deformity (Bauer's Bump, named after hockey brand). . . I actually wasn't seeing a professional for it.  I was "skating through the pain."   Rather, I went to an orthopedic doctor for another issue; a HUGE bump above my left ankle, on the outside of my leg.  It was caused by breaking in those Riedell skates.  It was so big, that it caused the bottom of my foot to go numb when in skates.  The orthopedic surgeon took MRIs and a biopsy of it.  Because it was affecting a nerve to the foot, the surgeon removed it in a real operation.  It was a ganglion cyst.  In time, I healed 100%. 

Anyway, the orthopedic surgeon had a podiatrist in the office with him (part of HMO where specialty doctors worked together in same office).   Both worked on my feet, one on the ankle bump and the other on the Bauer Bump.  I was cured.

Then, after having baby #2, I developed very bad plantar facitis.  This was caused by pregnancy hormones which loosened all ligaments/tendons, but especially this one.  I started at a podiatrist, who sent me to physical therapy, who sent me to an orthopedic doctor after thinking I had internal "lumps & bumps" inside my foot, who did MRIs, who then said nothing major/cancer (yeah, he used that word) was wrong, back to podiatrist . . .    Anyhow, I discovered yoga.  Basically, yoga's intensive stretching and breathing oxygen helped heal it.  The physical therapist was trying to stretch me a day a week, but yoga each day is what cured me.

Anyhow, the devil should make me an Olympic champion.  Cuz, he sure has done a number on my tootsies.

[slcbelle]

A neighbor of mine is Dr. Craig McQueen who is the former Chairman of the US Figure Skating Association's Sports Medicine Committee and has worked with figure skaters for 30+ years at the elite and Olympic levels.  I gave him a call and he saw me in his office right away.  He took an xray and examined my feet and the verdict is that I do have a bony prominence there, but no bursa, and the only solution is to get custom boots.  That I've modified my stock boots as much as I can and, because of my other foot/ortho issues such as pronation, bunions, high cuniform, and narrow heels with a proclivity to Haglund's, I need custom boots.

ARGH.

[Neverdull44]

I went to the podiatrist today. 

He explained that I was born with it.  The top, back of my heel bone on my right foot goes up to a point, at almost a 90 degree angle.  The left foot doesn't have this as much.  When I modified my skating boot, it raised my footbed slight enough for a bursa to form over the protruding bone.  This is that "bump" part of it.

He gave me a shot of cortisone and a free silicone sleeve my ankle. He doesn't want me to skate tomorrow, but Thursday I should be ok. 

But, he thinks it's going to come back, and he suggested the "operation" (cut bone) word . . . before gov't healthcare sets in.  He doesn't like to give too many cortisone shots a year - 1 a year max.  Because my Haglunds is far over to the side of my heel, almost to the side of my foot, he said that not much, if any, of the archilles tendon would be touched.  He thinks that I'll be walking in a few days, able to "piddle around" skate in 2 weeks, and able to skate hard in 6 weeks.

After I left the doctor's office, I noticed that my bump had widened and moved. It went from about as big as the one pictures on this thread to about 4 times the size and below my ankle!    The original bump is gone.  I guess he popped my bursa with the cortisone shot.

By the way, he thought the bump was huge.  He doesn't see too many figure skaters here in South Florida.  LOL.

[slcbelle]

I went to the podiatrist today, too.  Awww.  We're twins!

Are you going to have surgery?

He said that the best temporary solution, until I get custom boots, is to buy some 1/4" adhesive felt...not moleskin...and cut a circle with a donut hole for the bump and stick it on my heel.  The 1/4" is thicker than moleskin and the name of the game is to prevent pressure, not to soften pressure as with Bunga pads.  He said my skate orthotics are not stiff and pushed on them to show that when I pronate, I just flatten the damn thing.  To make sure that Harlick, when they measure me and take an impression, account for all my issues:  Haglund's, bunions on both sides, that I need a metatarsal pad, and the bony prominence of the cuneiform bones.

Here's the felt:

http://www.amazon.com/900095-Padding-Adhesive-Orthopedic-Corporation/dp/B0053D319Q/ref=sr_1_1?s=hpc&ie=UTF8&qid=1370384950&sr=1-1&keywords=1%2F4+adhesive+felt

I made an appointment at Harlick for June 18th.  Seriously, if custom boots don't do the trick, I will have to give up.  I'm not going to purposely put myself on a path to crippling pain and surgery.   

[Neverdull44]

Yes, we are twins.  The more I think about, I want a second and third opinion if the shot doesn't work.  Everyone says stretching, and I've hardly done yoga lately.  So, it's going to be more yoga, starting tomorrow morning.  I will only do sitting poses for 5 days and swimming.

Surgery is forever.  What I've read, is that some people have a terrible time recovering.  With how skating is, I want to be assured I will skate again. 

"Acta Orthop Belg. 2005 Dec;71(6):718-23.
Physician and patient based outcomes following surgical resection of Haglund's deformity.
Brunner J, Anderson J, O'Malley M, Bohne W, Deland J, Kennedy J.
Source
Hospital for Special Surgery, Department of Foot and Ankle Surgery, New York, NY, 10021, USA.
Abstract
Calcaneal ostectomy is the benchmark for definitive surgical treatment in patients with Haglund's syndrome, despite conflicting and unpredictable study results. The current study's hypothesis is that when adequate bone is resected and outcomes are evaluated using validated scores, calcaneal ostectomy can give reliable and predictable results. Thirty six consecutive patients (39 feet) underwent calcaneal ostectomy for Haglund's deformity between 1998 and 2002. All patients were evaluated with the AOFAS score and SF-36v2 questionnaire. The mean time to follow-up was 51 months. The mean AOFAS score following surgery was 86/100 points; the mean SF-36v2 score following surgery was 144/152. Six of the 36 patients interviewed, however, would not recommend the procedure to others, citing mainly prolonged recovery time. Calcaneal ostectomy achieves good-to-excellent results in the treatment of Haglund's deformity when appropriate amounts of bone are excised. However, patients must be made aware of the necessary time to recovery, between 6 months and 2 years."

[Neverdull44]

One  day after the corisone shot . . .

I have a large "fat blob" underneath my ankle . . . AND, my bump is back.

Tomorrow I skate.  I bought moleskin, and will be making a hole to protect the bump.  To hold it in place, I am going to use good old duct tape.  I used to use duct tape over bandaids to help blisters heal.  Hope it hels the bump too.

[slcbelle]

One  day after the corisone shot . . .

I have a large "fat blob" underneath my ankle . . . AND, my bump is back.

Tomorrow I skate.  I bought moleskin, and will be making a hole to protect the bump.  To hold it in place, I am going to use good old duct tape.  I used to use duct tape over bandaids to help blisters heal.  Hope it hels the bump too.

DOH!  That's no good at all!  Want to go to Harlick with me on the 18th?  Hehe.

[Neverdull44]

I have Harlicks, but was too stupid and "modified" the footbed for my plantar . . . which raised my heel  .. . which caused the bump.

[Neverdull44]

Skated today withoout pain!   I put duct tape right on my skin, followed by the archilles gel pad sleeve, followed by skating socks.   My boot felt a little wierd (landing leg), but I skated just as good/bad as normal.  So, I think this is going to be how it works for now.

[slcbelle]

Skated today withoout pain!   I put duct tape right on my skin, followed by the archilles gel pad sleeve, followed by skating socks.   My boot felt a little wierd (landing leg), but I skated just as good/bad as normal.  So, I think this is going to be how it works for now.

EXCELLENT!  Bravo!  I'll try it.  I have the gel sleeve.  How do you place the duct tape (horizontally, vertically, or just a square?) and how do you get it off?

[Neverdull44]

I put duct tape on the back of my heel, about a 2" slab of it.  It peels right off, but you may have to use a scrubbie in the shower to get it all the way off.

I used duct tape before for blisters and sore spots.  But, with blisters/broken skin, you have to put on antibiotic cream & band-aid first.  Duct tape takes the friction, so your skin doesn't have to.  It's so strong that it keeps anything underneath in place.  I learned about using duct tape from my dad.  He was a hiker/backpacker.

[aussieskater]

ND44, how long do you need to leave between "duct tape" sessions?  That stuff is stronger than skin; will you lose skin when you pull it off, if used several times in a week?