Zadek’s calcaneal osteotomy for insertional Achilles pathology

N.K. Kelsall, A.W. Chapman, A. Sangar, M.J. Farrar, H.P. Taylor

Introduction: The dorsal closing wedge calcaneal osteotomy has been described for the treatment of insertional pathology of the tendo-achilles. The aim of this study was to evaluate the efficacy of the technique using outcome measures.

Method: This was a prospective case series. Patients were included if they had tendo-achilles insertional pathology (calcific tendonitis, bursitis or Haglund’s deformity). A short extended lateral approach was used and a 1 cm dorsally based closing wedge osteotomy of the calcaneus performed. Fixation was with 2 staples. Patients were scored pre-operatively and at 6 and 12 months post-operatively using the VISA-A and AOFAS ankle-hindfoot scores. Results were analysed with the paired student t-test.

Results: Twenty five feet in 23 patients were enrolled in the study February 2011 - May 2013. 22 patients underwent the osteotomy (9 males and 14 females). Average age was 47.2 years (range 19-62 years).12 feet have been followed up for 1 year, 6 for 6 months, 5 less than 6 months. Average VISA-A improvement was 27.87 points (-13 - 71) at 6 months p=0.001 and 38 (-13 - 81) at 12 months p=0.001. Average AOFAS improvement was 11 points (-8 - 31) at 6 months p=0.005 and 11 (-18 - 42) at 12 months p=0.04. 82.3% of patients would have the procedure again. Complications included minor wound problems (3), sural nerve symptoms (1) and plantar fasciitis (3). All complications have resolved.

Conclusion: The results of this study show that the use of the Zadek osteotomy of the calcaneus can provide consistent symptomatic relief from insertional Achilles pathology by altering the biomechanics of the tendon without disrupting the bursa. There is a small risk of minor complications, which should be included in the consent process.