Improving Outcomes, Reducing Recovery Time in Patients with Insertional Achilles Tendinopathy

The minimally invasive procedure percutaneous Zadek osteotomy can improve functional outcomes while significantly reducing pain, recovery time, and postoperative complications in patients with insertional Achilles tendinopathy, according to a report published in the journal Foot and Ankle Surgery.

Insertional Achilles tendinopathy, a chronic degenerative condition, can be particularly painful for athletes who perform push-off activities, such as basketball and soccer players. Surgeons from the Mount Sinai Health System have found that by using the percutaneous Zadek osteotomy technique, they can provide pain relief in as little as 6 weeks after surgery, compared with 23 weeks for recovery after the traditional open procedure.


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“The 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 Ettore Vulcano, MD, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai and co-author of the paper.

“As a result of cutting-edge technology and the latest techniques at Mount Sinai, 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.”

Dr. Vulcano, one of only a few doctors in the US to revolutionize the minimally invasive approach, said the procedure includes making 2 very small incisions in the heel and removing a 5-mm wedge of bone, which alters the orientation of the tendon fibers and is believed to decrease stress across the tendon.

The short recovery period includes protecting the foot in a splint or walker boot for 2 weeks, then resuming weight bearing while wearing a removable walker boot for an additional 4 weeks. Physical therapy can also begin 2 weeks after surgery. Patients are allowed to return to shoes 6 weeks after the outpatient procedure.

Click here to listen to Dr. Vulcano describe the procedure.



Nordio A, Chan JJ, Guzman JZ, Hasija R, Vulcano E. Percutaneous Zadek osteotomy for the treatment of insertional Achilles tendinopathy. Foot Ankle Surg. 2019 Nov 20. pii: S1268-7731(19)30182-1. doi: 10.1016/j.fas.2019.10.011. [Epub ahead of print]


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