Calcaneal osteotomy due to insertional calcaneal tendinopathy: preoperative planning

Abstract

Purpose Dorsal closing wedge calcaneal osteotomy (DCWCO) is indicated in patients with insertional tendinopathy of the calcaneal (Achilles) tendon. The Chauveaus-Liet’s (CL) angle is represented by the difference between the angle of verticalization (α) and morphological angle (β) of the calcaneus (CL angle = α − β). The purpose of the study was to assess whether the DCWCO affects the Chauveaus-Liet’s angle. Methods The study included 12 patients indicated to DCWCO. Three directions of close wedge osteotomy were designed for each patient—horizontal, vertical and in the middle type of osteotomy and a virtual osteotomy was created in each of them in the ABAQUS system in cooperation with Czech Technical University. The most used directions of osteotomy according to the available literature were used. We evaluated α and β angles before and after osteotomy, changes of the length plantar aponeurosis and the elevation of distal insertional point of the calcaneal tendon. The changes of grades, median and standard deviation were observed. Results The change of the alfa angle was dependent on the direction of the osteotomy and the change of the beta angle was affected by the size of the osteotomy. The greatest elevation of the distal insertional point of the calcaneal tendon occurred in the horizontal type of the osteotomy. Conclusion Our study shows that the more we want to reduce the tension in the calcaneal tendon, the more we have to perform an osteotomy horizontally. This study could serve as a preoperative guide for osteotomy planning.

Minimally Invasive Approaches to Haglund’s Deformity and Insertional Achilles Tendinopathy: A Contemporary Review

“…It was first described in 1939 as an open technique for the treatment of IAT. 20,43,76 The ZO was subsequently demonstrated to be an effective approach to Haglund syndrome by Keck and Kelly in 1965. 4,8,30 The ZO rotates the Achilles insertion anteriorly, decompressing the posterior heel and functionally lengthening the gastrocnemius complex, which in turn 19 improves dorsiflexion and relieves pathological strain at the Achilles insertion.…”

“… 30 , 49 , 62 The indications for this procedure have since been expanded to include patients presenting with chronic IAT with or without intratendinous calcification. 12 , 43 , 49 The Achilles insertion remains untouched during the ZO correction, reducing recovery time. Therefore, this may be a preferred intervention for patients presenting with significant IAT or concomitant Achilles pathology.…”

The surgical learning curve for percutaneous Zadek osteotomy for treatment of insertional achilles tendinopathy

“…More recently, this strategy has resurfaced in the literature as a minimally invasive (MIS) techniques [2][3][4][5][6]. Generally, MIS has been associated with lower postoperative complications, better cosmesis, and less postoperative pain [2,[7][8][9][10].…”

Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy and Haglund Deformity: A Technique Tip

“…8 The Zadek osteotomy includes the reduction of the Achilles tendon impingement by rotating the posterosuperior corner of the calcaneal tuberosity anterior and elevating the Achilles tendon insertion. 4 This technique has been used to treat IAT, with or without associated Haglund deformity. More recently, this strategy has been modified through the use of minimally invasive techniques, including the percutaneous Zadek osteotomy.…”

“…Insertional Achilles tendinopathy (IAT) is a common surgical pathology treated by orthopaedic surgeons. 4 IAT may be associated with Haglund deformity, and several surgical approaches exist to correct IAT; the most frequently used technique is the open midline splitting approach. More recently, minimally invasive surgery (MIS) to address common foot and ankle conditions has increased in use and popularity.…”