Early Outcomes after Minimally Invasive Percutaneous Zadek Osteotomy for the Treatment of Insertional Achilles Tendinitis and Haglund’s Deformity

Abstract

Category: Hindfoot; Other Introduction/Purpose: Zadek dorsal closing wedge calcaneal osteotomy (DCWCO) has been increasingly investigated as an effective technique for the treatment of Insertional Achilles Tendinopathy and Haglund’s deformity. More recently, this strategy has been modified using minimally invasive techniques. A percutaneous approach, in comparison to the standard open DCWCO, allows for reduced postoperative complication, improved clinical function, and decreased pain. This retrospective chart review aims to evaluate the postoperative outcomes of patients undergoing Zadek osteotomy via a minimally invasive percutaneous approach to assess early functional outcomes, complication rates, and revision rates. Methods: Two fellowship-trained foot and ankle orthopaedic surgeons at one academic institution performed minimally invasive percutaneous Zadek osteotomies on 21 patients. All cases were completed between March 2021 and February 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Results: Average age of patients was 54 years. Average BMI was 39.4. Average follow up was 111.6 days. Complications included 1/21 (4.7%) superficial infection that resolved with oral antibiotics, 1/21 (4.7%) tibial neuritis that resolved 3 months after surgery, and 1/21 (4.7%) postoperative plantar fasciitis that resolved with home stretching by 6 months. There were no revisions to open procedures or hardware removal. All participants achieved union. 20/21 (95%) were very satisfied with their surgery. Average preoperative PROMIS scores regarding physical function, pain interference, and mobility were 38.3 (27-51), 65.1 (55-75), and 35.0 (25-46), respectively. Average postoperative PROMIS scores in these same domains were 38.5 (19-54), 58.8 (39-72), and 36.8 (22- 51). There was an average improvement in PROMIS scores in all domains (0.23, -6.35, and 1.76). Conclusion: Minimally invasive percutaneous Zadek osteotomy appears to be an efficacious and safe treatment option for insertional Achilles tendinitis and Haglund’s deformity with low complication profile, high union rate of the osteotomy and high patient satisfaction. Early functional outcome data shows trends in improvements in PROMIS scores. However, longer term data will be needed to assess long term functional outcomes and revision rates.