Treatment for Chronic Achilles Tendon Disorder Improves Outcomes

Treatment for Chronic Achilles Tendon Disorder Improves Outcomes

A key-hole procedure known as percutaneous Zadek osteotomy can significantly decrease pain.

By Mount Sinai Health System02.25.20
A minimally invasive procedure to treat a common foot and ankle disorder can reduce pain, recovery time, and postsurgery complications while improving functional outcomes, according to a published report.
The procedure treats insertional Achilles tendinopathy, a common and chronic orthopedic disorder in which patients experience pain at the Achilles tendon. The chronic degenerative condition can be particularly painful for athletes who perform push-off activities, such as basketball and soccer players.
The key-hole procedure, known as percutaneous Zadek osteotomy (ZO), can significantly decrease pain and provide a patient with relief in as little as six weeks after this technique compared to 23 weeks for recovery after the traditional open surgery. A study published in Foot and Ankle Surgery showed that percutaneous ZO led to a significant improvement (p<0.0001) in preoperative to postoperative FFI (from 65±9 to 8±12) and VAS (from 9±1 to 1±2). Two postoperative complications (8 percent) were observed: a case of symptomatic non-union and hardware pain, both in healthy patients. The overall rate of satisfaction after surgery was (92 percent). The relief from pain was achieved after an average period of 12 weeks. 

“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, M.D., assistant professor of Orthopedics at the Icahn School of Medicine at Mount Sinai, an orthopedic surgeon at Mount Sinai West, and co-author of the report, which was published last fall. “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 a few doctors in the nation to revolutionize the minimally invasive approach—said the procedure includes making two very small incisions in the heel and removing a 5mm 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 two weeks, then resuming weight bearing while wearing a removable walker boot for an additional four weeks. Physical therapy can also begin two weeks after surgery. Patients are allowed to return to shoes six weeks after the outpatient procedure.
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