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Percutaneous Zadek Osteotomy for Calcific Insertional Achilles Tendinopathy: An Exploratory Comparison of Outcomes
Dhivakaran Gengatharan1, Inderjeet Singh Rikhraj1,2, Hon Keng Pui Bryan1
1Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore.
Background:
Calcific insertional Achilles tendinopathy (CIAT) may remain symptomatic despite prolonged nonoperative treatment. Minimally invasive (MIS) Zadek osteotomy unloads the Achilles insertion biomechanically, but whether calcific deposits require excision remains unclear.
Methods:
This exploratory comparative case series included 20 consecutive patients undergoing MIS Zadek osteotomy. Patients were grouped based on the presence (n = 10) or absence (n = 10) of calcification. Outcomes included visual analog scale (VAS) and European Foot & Ankle Society (EFAS) scores. Non-parametric statistical analysis was performed.
Results:
Both groups demonstrated substantial improvement, with median VAS decreasing from 7 (IQR 2) to 0 (IQR 1) at 1 year. EFAS scores improved from 12 (IQR 6) preoperatively to 24 (IQR 2) at final follow-up. With the numbers available, no significant between-group difference could be detected in VAS (P = .349), EFAS at 6 months (P = .939), or EFAS at 1 year (P = .932).
Conclusion:
MIS Zadek osteotomy was associated with substantial clinical improvement regardless of calcification. Excision of calcific deposits may not be necessary in all cases, although larger studies are required.
Level Of Evidence:
Level IV, case series.
