Dorsal closing wedge calcaneal osteotomy for the treatment of Insertional Achilles Tendinopathy: A technical tip to optimize its results and reduce complications

Abstract

Background: Dorsal closing wedge calcaneal osteotomy is a technique for the treatment of Haglund's triad, which is considered a safe procedure with good results. However, one of the complications that could lead to revision operation is the nonunion of the osteotomy and failure of osteosynthesis. This is attributed to instability of the osteotomy site and proximal migration of the posterior calcaneal process due to breakage of plantar bone-bridge at the apex of the wedge osteotomy.

Methods: This study presents a technical tip that helps the surgeon to avoid the breakage of the plantar hinge of the os calcis which is believed that causes instability of the osteotomy.

Results: After the utilization of that technical tip, no proximal migration of posterior calcaneal process or subsequent nonunion and failure of the osteosynthesis was noted.

Conclusion: Dorsal closing wedge osteotomy is a technique for the treatment of IAT, which is considered a safe procedure with good results. The proposed technical tip helps to avoid the breakage of the plantar hinge which is believed that causes instability of the osteotomy with proximal migration of the posterior calcaneal process and subsequent nonunion and failure of the osteosynthesis.

Keywords: Achilles tendinopathy; Calcaneal osteotomy; Complications; Surgical treatment.