Early Outcomes Following Percutaneous Closing Wedge Calcaneal Zadek Osteotomy for Insertional Achilles Tendinopathy: A Multi-Centre Study

Research Type: Level 4 – Case series Introduction/Purpose: There has been increasing interest in the percutaneous dorsal closing wedge Zadek calcaneal osteotomy for the treatment of insertional Achilles tendinopathy (IAT). This study aims to investigate the clinical efficacy and radiographic outcomes of the percutaneous dorsal closing wedge Zadek calcaneal osteotomy, Methods: A multicentre observational study of patients undergoing percutaneous dorsal closing wedge Zadek osteotomy for IAT. The primary outcome was radiographic parameters, including the X/Y ratio and calcaneal pitch. Clinical outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS) for pain, and EQ-5D scores. Results: Between April 2022 and December 2024, 49 feet (47 patients; 20 male, 27 female) with mean age 56.2±12.7 years (range:21.5-77.6) underwent percutaneous Zadek osteotomy with a mean clinical follow-up of 0.94±0.64 years and mean radiographic follow-up of 0.51±0.37 years. Radiographic analysis showed a significant increase in the X/Y ratio (2.46±0.28 to 3.11±0.49, p< 0.0001) but no significant change in calcaneal pitch (25.23±5.34° to 25.32±5.69°, p=0.8749) or calcaneal height (18.57±7.93 to 18.66±7.85, p=0.9116). Clinical outcomes demonstrated significant improvement in all MOXFQ domains (Index: 63.68±15.95 to 34.92±24.60, p< 0.0001; Pain: 66.30±15.09 to 37.98±23.88, p< 0.0001; Walking: 72.85±19.98 to 39.34±29.28, p=0.0001; Social: 44.35±21.46 to 23.35±23.08, p=0.0001), VAS Pain (54.96±16.96 to 21.61±21.22, p< 0.0001), and EQ-5D scores (Index: 0.56±0.20 to 0.73±0.15, p=0.0012; VAS: 61.57±15.78 to 72.65±15.01, p=0.0117). No non-unions were reported. Conclusion: Percutaneous Zadek calcaneal osteotomy is a safe and effective procedure for IAT, associated with significant improvements in foot function and pain relief. However, further research is needed to explore its long-term outcomes and biomechanical effect on function.