Percutaneous Osteotomy Procedure Treats Achilles Tendon Disorder

A minimally invasive procedure to treat insertional Achilles tendinopathy (IAT) can reduce pain, recovery time, and postsurgical complications, according to a new study.

Researchers at Azienda Sanitaria Universitaria Giuliano Isontina (Trieste, Italy) and Mount Sinai Health System (MSHS, New York, NY, USA) conducted a study involving 26 patients presenting with unilateral IAT who were treated via percutaneous Zadek Osteotomy (ZO), a minimally invasive procedure that involves two very small incisions in the heel and removal of a five mm wedge of calcaneal bone, which alters the orientation of the Achilles tendon fibers and is believed to decrease stress across the tendon.

The results showed that percutaneous ZO significantly improves preoperative to postoperative Foot Function Index Score (FFI) and Visual Analogue Scale (VAS) scores (from a mean of 9 to 1). The overall rate of satisfaction after surgery was 92%, and only two postoperative complications were observed - symptomatic non-union and hardware pain, both in healthy patients. Relief from pain was achieved after an average period of 12 weeks. The study was published on November 20, 2019, in Foot and Ankle Surgery.

“Traditional surgery requires larger incisions and inevitably carries a higher rate of infection, while this minimally invasive procedure has a low infection rate and less risk of tissue damage, helping to better preserve the tendon, and achieve a faster recovery and rehabilitation for the patient,” said senior author orthopedic surgeon Ettore Vulcano, MD, of Mount Sinai West. “Patients experience much less pain and improved function at a quicker rate. Even athletes can resume previous levels of sports activity at a much quicker rate compared to the traditional surgery.”

IAT is a common condition among athletes and joggers, resulting from mechanical overuse related to sports activity, or a systemic inflammatory disease. The clinical appearance includes pain and movement restriction, and the primary treatment is conservative. When this fails, calcaneal osteotomy is performed to decompress the dorsal margin of the calcaneus; and if the tendon has degenerated, debridement is also needed.

Related Links:
Azienda Sanitaria Universitaria Giuliano Isontina
Mount Sinai Health System