Percutaneous Zadek osteotomy for the treatment of insertional Achilles tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a challenging common lower extremity disorder, despite several treatment options described in literature. Open dorsal closing wedge calcaneal osteotomy or Zadek Osteotomy (ZO), for the treatment of the IAT has good clinical results but a high rate of postoperative complications. The purpose of this study is to describe percutaneous ZO for the treatment of the IAT and to evaluate its impact on the clinical and functional postoperative outcomes. Methods: Twenty-six consecutive patients presenting with unilateral IAT refractory to nonoperative measures were treated with percutaneous ZO. Visual Analogue Scale (VAS) and Foot Function Index Score (FFI) were recorded preoperatively and at final follow-up visit (12 +/- 3) months. Postoperative complications, satisfaction, and relief of the pain were also recorded. Results: The percutaneous ZO showed a significant improvement (p <0.0001) in preoperative to postoperative FFI (from 65 +/- 9 to 8 +/- 12) and VAS (from 9 +/- 1 to 1 +/- 2). Two postoperative complications (8%) were observed: a case of symptomatic non-union and hardware pain, both in healthy patients. The overall rate of satisfaction after surgery was (92%). The relief from pain was achieved after an average period of 12 weeks. Conclusions: ZO is a safe and effective procedure for the treatment of IAT. The use of a minimally invasive surgical approach is associated with excellent pain reduction (VAS score) and improved clinical function (FFI score). When compared to the open surgical approach, the percutaneous ZO may decrease recovery time and postoperative complications. (C) 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.