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Biomechanical Changes to the Hindfoot After Zadek Osteotomy
Nicholas Bellas1, Raghunandan Nayak1, Mehreen Pasha1
1The University of Connecticut, Department of Orthopedics, Farmington, CT, USA.
Foot & Ankle International
|October 13, 2024
Summary
The Zadek osteotomy (ZO) reduces heel pain by decreasing retrocalcaneal pressure and altering Achilles tendon insertion. This surgical procedure for insertional Achilles tendinopathy (IAT) shows biomechanical benefits in cadaver studies.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Foot and Ankle Anatomy
Background:
- Insertional Achilles tendinopathy (IAT) causes heel pain in active individuals.
- The Zadek osteotomy (ZO) is a surgical treatment for IAT, aiming to improve mechanics and reduce impingement.
- The mechanism of ZO's effectiveness for IAT requires further biomechanical investigation.
Purpose of the Study:
- To biomechanically evaluate the Zadek osteotomy (ZO).
- To assess ZO's effects on Achilles strain, Haglund prominence position, and retrocalcaneal pressure.
- To understand the mechanism of symptom relief for IAT patients undergoing ZO.
Main Methods:
- The Zadek osteotomy (ZO) was performed on 10 cadaveric foot and ankle specimens.
- Retrocalcaneal pressure and Achilles strain were measured pre- and post-osteotomy using specialized sensors.
- Statistical analysis using paired t-tests identified significant biomechanical changes (P < .05).
Main Results:
- The ZO translated the Haglund prominence anteriorly and the Achilles tendon insertion proximally (P < .05).
- Retrocalcaneal pressure significantly decreased by 44% post-osteotomy (P = .018).
- Achilles tendon strain showed no significant change in anterior or posterior fibers (P > .05).
Conclusions:
- The Zadek osteotomy (ZO) effectively reduces retrocalcaneal pressure and alters calcaneal geometry.
- ZO shifts the Achilles tendon insertion proximally, potentially alleviating IAT symptoms.
- While not significantly altering Achilles strain, ZO offers biomechanical advantages for IAT treatment.
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