Summary
Zadek MIS osteotomy shifts VAS from 10/10 to 1/10 in the immediate postoperatory evaluation. Preliminary results of a pilot study.
Abstract
Introduction
Zadek osteotomy (closing wedge calcaneal osteotomy) was first described in 1939 as an effective technique for the treatment of insertional Achilles tendinopathy; it considers the reduction of the Achilles tendon impingement by rotating the posterosuperior corner of the calcaneal tuberosity anterior and elevating the Achilles tendon insertion through an open approach. Percutaneous Zadek osteotomy has been recently published, and in comparison to the open technique, it reports fewer postoperative complications and decreased pain.
Objective
To describe the preliminary results (short-term) of a clinical and radiological outcome study following Zadek MIS osteotomy.
Methods
A prospective study of patients percutaneous Zadek osteotomy for patients with insertional Achilles tendinopathy after failure of nonoperative management is being conducted. The study includes measurement of the Visual Analogue Scale (VAS) preoperatively and at 1 month/3 months/6 months and 12 months postoperative mark and Achilles VISA score preoperatively and at 3 months/6 months/12 months postoperative mark. The study also includes a radiological analysis of their pre and postoperative Fowler-Philip angles and X/Y relation using postoperative radiographs.
Results
3 patients, 2 bilaterals (5 Zadek osteotomies) have been enrolled so far, 2 women and 1 man, with an average age of 50 years old (48-53 ), all of them were obese with a BMI of 34.6 (32.4-35.8), and none of them performed any physical activity. The mean duration of symptoms was 40 months (12-72), with pain VAS 9/10 (7/10-10/10). At the 30-day evaluation, the VAS improved from 9/10 to an average of 0.8/10 (4/10-0/10). No wound complications were reported. Radiological results showed a Fowler-Philip preop of 62 and postop of 52. The relation X/Y preop was 2.7 and 4.1 postoperative.
Conclusion
The Zadek MIS osteotomy is a safe procedure and significantly improves pain at immediate postop.
Clinical relevance: we present these early results because of the significant pain relief in the immediate evaluation of all the patients, 4/5 with VAS 0/10 at 30 days.