Zadik Osteotomy Research Continues to Emerge for Treatment of Haglund's Triad

For the operative treatment of insertional Achilles tendinopathy with Haglund’s Impingement and Retrocalcaneal Bursitis, protracted postoperative recovery times, complications, and persistent complaints in shoe wear after complete detachment of the tendon and resection have left many surgeons asking, “Is there a better way?”

Did we overlook a good thing?

Although introduced almost a century ago, the Zadik osteotomy has received little attention until recently – relegated in many instances to cavus-type foot structures, probably owing to its learning curve.

The dorsally based closing wedge calcaneal osteotomy positions its apex to the plantar calcaneal tubercule, shortening the calcaneus and elevating the insertion of the Achilles, removing contact between the Haglund’s “bump” and the Achilles tendon, all while reducing stress on the tendons insertion.

The technique, therefore, addresses both the mechanical and biological perturbations associated with the condition, while negating the need for complete tendon detachment and associated complications.

The latest research: a new “X/Y” Ratio and short-term outcome data

Two new retrospective case series by Yves Tourne, MD-PhD, et al. were recently published in Foot & Ankle Surgery:

The first report, "The Zadek calcaneal osteotomy in Haglund's syndrome of the heel: Clinical results and a radiographic analysis to explain its efficacy," introduces the “X/Y Ratio." It is a new measurement parameter defined as the ratio between the posterior length of the calcaneus “Y” and the total length of the calcaneus “X” (value <2.5 is considered pathologic), and reports positive clinical results in a cohort of 50 patients at a mean follow-up of seven years postoperative.

The second report, "The Zadek calcaneal osteotomy in Haglund’s syndrome of the heel: Its effects on the dorsiflexion of the ankle and correlations to clinical and functional scores," shows an increase in ankle dorsiflexion by an average of 7.27 degrees, with significant improvement in functional scores using various assessment scales.

The truth is ...

While the jury is still out, more comparative outcome data may bring back an osteotomy that many considered to be of only historical significance.