A suite of surgical interventions exists for insertional Achilles tendinopathy (IAT,) including flexor hallucis longus (FHL) tendon transfer, tendon-tissue debridement, and, most commonly, open Achilles tendon-splitting procedures. More recently, a percutaneous approach to the Zadek dorsal closing wedge osteotomy (ZO) has been employed as a promising alternative to traditionally open-approach interventions.

In this Orthopedic Video Theater we cover the history of the Zadek Osteotomy while presenting a case of a 78 year old male that has undergone the percutaneous Zadek Osteotomy. In outlining the approach we discuss how insertional Achilles tendinopathy is presented and diagnosed, current literature, who would be a candidate, a demonstration of the procedure, and the post operative protocol.

In the end it is shown that the percutaneous Zadek osteotomy is a viable procedure for insertional Achilles tendinopathy with the advantages of a minimally invasive approach.