title: Treatment of Insertional Achilles Pathology With Dorsal Wedge Calcaneal Osteotomy in Athletes.
abstract: BACKGROUND
  Insertional Achilles tendinopathy and retrocalcaneal bursitis is difficult to treat, and several operative techniques have been used after failure of conservative management. Dorsal wedge calcaneal osteotomy has been described for the treatment of insertional Achilles pathology. It was hypothesized that dorsal wedge calcaneal osteotomy would be an effective and safe method for the treatment of athletes with insertional Achilles pathology unrelieved by nonoperative measures.
  
  
  METHODS
  Fifty-two athletes (64 feet) who had painful Achilles tendon syndrome unrelieved by 6 months of nonoperative measures were treated surgically. Dorsally based wedge calcaneal osteotomy was performed through a lateral approach, and 2 staples were used for fixation. Patients were scored pre- and postoperatively with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot and Victorian Institute of Sports of Australia-Achilles (VISA-A) scores.
  
  
  RESULTS
  At a minimum follow-up of 3 years, the patients' AOFAS and VISA-A scores improved from 59.5 ± 15.0 and 65.9 ± 11.1 preoperatively to 95.7 ± 6.2 and 90.2 ± 8.4 postoperatively, respectively. Clinical results were considered excellent in 38 patients, good in 12 patients, and fair in 2 patients. Return to previous sports activity time was 21 (SD, 8.0) weeks. One patient necessitated a revision operation.
  
  
  CONCLUSIONS
  Operative treatment of insertional Achilles pathology in athletes with dorsal closing wedge calcaneal osteotomy was a safe and effective method that allowed for a quicker return to previous level of sports activities compared with other techniques.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: 1 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Hellas.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgiannos
authors.affiliation: 1 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Hellas.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Lampridis
authors.affiliation: 2 Department of Surgery, Division of Orthopaedic Surgery, General Hospital of Grevena, Hellas.
authors.forename: Angelos
authors.initials: A
authors.lastname: Vasiliadis
authors.affiliation: 1 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Hellas.
authors.forename: Ilias
authors.initials: I
authors.lastname: Bisbinas
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D056352:Athletes; D002062:Bursitis / Q000473:pathology*; D002111:Calcaneus / Q000601:surgery*; D006801:Humans; D010027:Osteotomy; D012086:Reoperation; D012189:Retrospective Studies; D052256:Tendinopathy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Zadek osteotomy; dorsal wedge calcaneal osteotomy; insertional Achilles tendinopathy; operative treatment; retrocalcaneal bursitis