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Related Experiment Video

Updated: Mar 18, 2026

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Radiation Exposure in Percutaneous Zadek Osteotomy vs Open Haglund Resection: A Retrospective Comparative Study.

Preston Harrison1, Sarah Hall Kiriluk2, John O'Keefe3

  • 1University of South Carolina School of Medicine Columbia, Columbia, SC, USA.

Foot & Ankle Orthopaedics
|March 16, 2026
PubMed
Summary

Minimally invasive surgery (MIS) like percutaneous Zadek osteotomy (ZO) uses more fluoroscopy and radiation than open Haglund resection (HR). However, radiation exposure for both procedures remains well below safety limits.

Keywords:
Haglund resectionMISZadek osteotomyhindfoot surgeryminimally invasive surgerypercutaneousradiation exposure

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Area of Science:

  • Orthopaedic Surgery
  • Medical Imaging
  • Radiation Safety

Background:

  • Fluoroscopy is crucial in orthopaedic surgery, especially with increasing minimally invasive surgery (MIS) adoption.
  • MIS may increase radiation exposure compared to open procedures, necessitating modern mini C-arm systems.
  • Concerns exist regarding radiation exposure for patients and staff during MIS.

Purpose of the Study:

  • To compare radiation dose and fluoroscopy time between percutaneous Zadek osteotomy (ZO) and open Haglund resection (HR) for insertional Achilles tendinitis.
  • To test the hypothesis that percutaneous ZO involves higher radiation dose and fluoroscopy time than open HR.
  • To ensure radiation exposure remains below occupational limits.

Main Methods:

  • Retrospective review of 139 patients undergoing percutaneous ZO or open HR.
  • Procedures performed by fellowship-trained foot and ankle surgeons at an academic institution.
  • Radiation exposure assessed via total radiation dose (mGy) and fluoroscopy time (minutes).

Main Results:

  • The percutaneous ZO cohort (60 patients) had a mean fluoroscopy time of 2.83 minutes and radiation dose of 3.25 mGy.
  • The open HR cohort (79 patients) had a mean fluoroscopy time of 0.42 minutes and radiation dose of 0.38 mGy.
  • Percutaneous ZO showed significantly higher radiation dose and fluoroscopy time (P < .001).

Conclusions:

  • Percutaneous ZO is associated with higher radiation dose and fluoroscopy time than open HR, though potentially not clinically significant.
  • Surgeons receive minimal radiation dose; exceeding annual limits would require ~1225 percutaneous ZO procedures.
  • Radiation exposure for percutaneous ZO is well below ICRP occupational limits, with low-dose settings and protective gear minimizing risk.