Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy and Haglund Deformity: A Technique Tip.

Abstract

Insertional Achilles tendinopathy (IAT) is a common surgical pathology treated by orthopaedic surgeons.4 IAT may be associated with Haglund deformity, and several surgical approaches exist to correct IAT; the most frequently used technique is the open midline splitting approach. More recently, minimally invasive surgery (MIS) to address common foot and ankle conditions has increased in use and popularity. The Zadek dorsal closing wedge calcaneal osteotomy (DCWCO) was first published by Zadek in 1939 for treatment of Haglund syndrome and was performed through an open approach.8 The Zadek osteotomy includes the reduction of the Achilles tendon impingement by rotating the posterosuperior corner of the calcaneal tuberosity anterior and elevating the Achilles tendon insertion.4 This technique has been used to treat IAT, with or without associated Haglund deformity. More recently, this strategy has been modified through the use of minimally invasive techniques, including the percutaneous Zadek osteotomy.5 A percutaneous approach, in comparison to the standard open technique, allows for fewer postoperative complications, improved clinical function, and decreased pain.5,6 Accordingly, we present a novel technique for performing the percutaneous Zadek osteotomy in an effort to improve accuracy of resection and selection of appropriate incisions.