Short-term Outcomes of Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy in Cavus vs Non-Cavus Feet: A Comparative Multi-Center Study

Background: There has been increasing interest in the percutaneous dorsal closing-wedge Zadek calcaneal osteotomy (PDCWZO) for the treatment of insertional Achilles tendinopathy (IAT). This study aims to investigate the clinical efficacy and radiographic outcomes of the percutaneous dorsal closing-wedge Zadek calcaneal osteotomy in patients with and without pes cavus foot morphology. Methods: A multicentre observational study of patients undergoing PDCWZO for IAT. Patients were stratified into cavus (calcaneal pitch angle > 20 degrees) and non-cavus (calcaneal pitch angle ≤ 20 degrees) groups. The primary outcome was the X/Y ratio and calcaneal pitch angle. Clinical outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ), visual analogue scale (VAS) for pain, and EuroQol–5 dimensions (EQ-5D). Between-group analyses were performed to identify differences in outcomes based on foot morphology. Results: Between April 2022 and December 2024, 67 feet (61 patients; 25 male, 36 female) with mean age 55.0 ± 12.7 years (range: 20.9-77.6) underwent percutaneous Zadek osteotomy with a median clinical follow-up of 0.56 years (IQR: 0.48-0.99) and median radiographic follow-up of 0.36 years (IQR: 0.13-0.49). The cohort included 50 cavus feet and 17 non-cavus feet. Radiographic analysis showed a significant increase in the X/Y ratio in both groups (cavus: 2.44 ± 0.27 to 3.08 ± 0.45, P < .001; non-cavus: 2.43 ± 0.28 to 3.05 ± 0.56, P < .001). Calcaneal pitch angle remained unchanged in both the cavus group (27.1 ± 4.2 degrees to 27.1 ± 4.6 degrees, P = .917) and non-cavus group (17.7 ± 1.7 degrees to 18.8 ± 4.8 degrees, P = .270). Clinical outcomes in all groups demonstrated significant improvement in all MOXFQ domains, VAS Pain and EQ-5D ( P < .05). The complication rate was 6.0%. Conclusion: At short-term follow-up (median 6.7 months), percutaneous Zadek calcaneal osteotomy demonstrated a low complication rate and was associated with improvements in foot function and pain relief for patients with both cavus and non-cavus feet. Level of Evidence: Level III, retrospective comparative study.