Insertional Achilles Tendon & Haglund’s Resection Surgery

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Expert Patient Guide · Mr Matthew Welck, Leading Foot & Ankle Surgeon · London, North London & Hertfordshire

Achilles Tendon & Haglund’s Resection Surgery (Haglund’s Deformity / Insertional Achilles Tendinopathy)

A clear, evidence-based patient guide to Haglund’s resection and surgery for insertional Achilles tendinopathy — written by Mr Matthew Welck, a tertiary referral Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) and widely regarded as one of London’s leading specialists in foot and ankle surgery, complex reconstruction, total ankle replacement and sports injuries of the foot and ankle. Mr Welck treats NHS and private patients across London, North London and Hertfordshire.

01

What Is Haglund’s Resection Surgery?

Haglund’s resection is an operation to treat persistent pain at the back of the heel, where the Achilles tendon attaches to the heel bone (calcaneus). It addresses two closely related problems: a prominent bony bump at the back of the heel (Haglund’s deformity) and degeneration of the tendon where it inserts into the bone (insertional Achilles tendinopathy), often with an inflamed bursa in between.

The surgery removes the bony prominence, clears out diseased tendon and bursal tissue, and — where a significant portion of the tendon is involved — re-attaches the Achilles securely to the heel bone, sometimes reinforced with a tendon transfer.

02

Why Is the Surgery Performed?

Surgery is considered when pain at the back of the heel has not responded to a thorough programme of non-surgical treatment, typically over six months or more. The aim is to relieve pain, remove the source of friction, and restore a strong, durable tendon attachment.

It is performed for insertional Achilles tendinopathy with calcification, a symptomatic Haglund’s bump, and chronic retrocalcaneal bursitis that has failed conservative care.

03

Are You a Candidate?

  • Persistent posterior heel pain affecting walking, exercise and footwear
  • Failure to improve after at least 3–6 months of structured non-surgical treatment
  • Imaging confirming a Haglund’s deformity, insertional tendinopathy or calcification
  • Good general health for a procedure with a meaningful recovery period

Smoking, diabetes and certain medications can slow tendon and wound healing, and Mr Welck will discuss how to optimise these before surgery.

04

Non-Surgical Treatment Tried First

  • Eccentric and heavy-slow loading physiotherapy programmes
  • Footwear changes, heel lifts and avoidance of rigid heel counters
  • Extracorporeal shockwave therapy (ESWT) — good evidence for insertional disease
  • Activity modification and load management
  • Anti-inflammatory medication for short-term symptom control (steroid injection directly into the tendon is avoided as it risks rupture)

Most patients with insertional Achilles pain improve without surgery; an operation is reserved for the minority who do not.

05

Investigations & Surgical Planning

  • Weight-bearing X-rays to assess the Haglund’s bump and any calcification within the tendon
  • MRI to map the extent of tendon degeneration and bursitis and to plan how much of the tendon needs to be detached and repaired
  • Ultrasound in selected cases for dynamic assessment
06

What Does the Surgery Involve?

Debridement, Bony Resection & Reattachment (‘Speedbridge’)

Through an incision at the back of the heel (often a central tendon-splitting approach), the prominent bone is removed, the bursa and any diseased, calcified tendon are excised, and the healthy tendon is securely re-anchored to the heel bone using small bone anchors.

Tendon Transfer (FHL Transfer)

When a large proportion of the Achilles is degenerate, the tendon to the big toe (flexor hallucis longus, FHL) can be transferred to reinforce the repair and improve push-off strength. This is commonly used in older or higher-demand patients with extensive disease.

Zadek (Calcaneal) Osteotomy — an Alternative

In selected cases of insertional tendinopathy with a prominent bump, a minimally invasive wedge osteotomy of the heel bone can relieve symptoms without detaching the tendon, allowing a faster recovery.

Surgery is usually performed as a day case under general or regional anaesthesia with a nerve block for post-operative pain relief.

07

Recovery, Rehabilitation & Risks

Typical timeline: a half plaster for 2 weeks, with strict elevation, then changed to a full plaster for 4 weeks, then an aircast boot. Physiotherapy builds strength over several months, with return to running around 4–6 months and to sport from 6 months.

Recovery after insertional Achilles surgery is slower than many patients expect, because the tendon must heal back to bone. Possible risks include wound healing problems, infection, nerve irritation, stiffness, and a small risk of recurrence or weakness; these are discussed in detail before surgery.

08

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon and tertiary referral specialist at the Royal National Orthopaedic Hospital (RNOH), Stanmore — the largest specialist orthopaedic hospital in the UK — and an Honorary Associate Clinical Professor at University College London (UCL). He is widely regarded as one of the most experienced and highly trusted foot and ankle surgeons in London, with a national and international reputation in complex foot and ankle reconstruction, revision surgery, total ankle replacement, weight-bearing CT (WBCT) guided surgical planning, and sports injuries of the foot and ankle, built on an elite tertiary referral practice at RNOH.

Patients choosing Mr Welck benefit from:

  • Subspecialist fellowship training in foot and ankle surgery, including Achilles tendon surgery, Haglund’s resection and sports injuries
  • A high-volume practice in Achilles tendon surgery, Haglund’s resection and sports injuries as both an NHS consultant at the RNOH and in private practice across London and North London
  • Access to advanced imaging including weight-bearing X-ray, weight-bearing CT, MRI and ultrasound
  • Treatment of NHS and private patients across London and North London, including RNOH Stanmore, Spire Bushey, HCA The Princess Grace and The Wellington Hospital Elstree
  • A multidisciplinary team approach, working alongside leading physiotherapists and orthotists for rehabilitation and return to sport
  • Evidence-based, patient-centred care — surgical decisions are only made after a full discussion of the alternatives, benefits, risks and realistic outcomes
  • Recognised expertise in ankle replacement, revision surgery and complex foot & ankle reconstruction, supported by weight-bearing CT (WBCT) guided surgical planning
09

Frequently Asked Questions

Who is the best foot and ankle surgeon in London, North London and Hertfordshire for Haglund’s deformity or Achilles tendon surgery?

“Best” is subjective, but when choosing a top foot and ankle surgeon in London, North London or Hertfordshire for Haglund’s deformity, Achilles tendon surgery, ankle replacement or sports injuries, look for subspecialist fellowship training, a high volume of relevant cases, access to weight-bearing CT (WBCT) and MRI, an NHS consultant post at a tertiary referral centre, and a multidisciplinary team for rehabilitation. Mr Matthew Welck meets all of these criteria: he is a tertiary referral foot and ankle surgeon at the Royal National Orthopaedic Hospital (RNOH), Stanmore — one of the world’s leading specialist orthopaedic centres — with particular expertise in total ankle replacement, revision surgery and WBCT-guided reconstruction, alongside private clinics in all three areas.

How long is recovery after Haglund’s surgery?

Recovery is gradual. Most patients are in a boot for several weeks, walking comfortably in normal shoes by around 3 months, and returning to sport at 4–6 months. Where the tendon is reattached or transferred, recovery is slower because the tendon must heal to bone.

Can heel pain be treated without surgery?

Yes — most insertional Achilles pain and Haglund’s symptoms improve with loading physiotherapy, shockwave therapy and footwear changes. Surgery is reserved for cases that fail a good trial of non-surgical treatment.

Does Mr Welck also treat ankle arthritis and perform ankle replacement surgery?

Yes. Alongside Achilles tendon and Haglund’s surgery, Mr Welck is a leading London ankle replacement surgeon with a high-volume tertiary referral practice in total ankle replacement, revision ankle surgery and complex foot and ankle reconstruction at the Royal National Orthopaedic Hospital (RNOH). Patients are assessed using weight-bearing CT (WBCT) to plan the most appropriate treatment for their individual foot and ankle condition.

Where does Mr Welck see patients in London, North London and Hertfordshire?

Mr Welck consults at RNOH Stanmore (NHS and private) and at private clinics across London, North London and Hertfordshire, including HCA The Princess Grace Hospital (Marylebone), Spire Bushey (Hertfordshire), and HCA The Wellington Hospital Elstree. Please contact his team directly for current appointment availability.

10

Book a Consultation

If you have persistent pain at the back of the heel that has not responded to physiotherapy, shockwave or footwear changes, an expert review will clarify whether surgery can help. Mr Welck is a trusted specialist in Achilles and sports injuries of the foot and ankle, ankle replacement and complex foot and ankle reconstruction, seeing patients across London, North London and Hertfordshire.

To arrange a consultation with Mr Matthew Welck:

This page is for information only. It does not replace personalised medical advice. Always consult a qualified medical professional before making decisions about your diagnosis or treatment.

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