Comparative outcomes of calcaneal osteotomy with and without Achilles tendon reinsertion in insertional Achilles tendinopathy: A randomized controlled trial

Background and Aim Insertional Achilles tendinopathy (IAT) is a degenerative disorder characterized by pain and functional limitation at the tendon’s calcaneal insertion. Surgical intervention is indicated when nonoperative management fails. This study aimed to compare clinical outcomes of calcaneal osteotomy with and without Achilles tendon reinsertion in patients with IAT. Methods In this double-blind randomized clinical trial, 42 patients (mean age: 52.25 ± 6.72 years; 69.0% male) with IAT were allocated equally to osteotomy with reinsertion (n = 21) or without reinsertion (n = 21). Functional status and pain were assessed preoperatively and at 3, 6, and 9 months postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot scale and the Visual Analogue Scale (VAS) for pain at rest and during activity. Complication rates were also recorded. Results In the reinsertion group, mean AOFAS scores improved from 51.00 ± 14.81 preoperatively to 66.33 ± 12.59 (3 months), 68.81 ± 20.54 (6 months), and 68.81 ± 20.54 (9 months). In the non-reinsertion group, scores improved from 55.10 ± 12.84 to 63.67 ± 14.22, 70.38 ± 13.14, and 70.38 ± 13.14, respectively. VAS scores for pain during activity and rest decreased progressively in both groups, approaching near-zero levels by 9 months. No statistically significant between-group differences were observed for AOFAS or VAS improvements ( p > 0.05). Complication rates were low and comparable between groups. Conclusion Both surgical techniques provided significant and sustained pain reduction and functional improvement over 9 months. Achilles tendon reinsertion did not confer measurable short-term advantages when a substantial portion of the native insertion was preserved, although potential long-term biomechanical benefits needs further investigation.