Procedure
Zadek Osteotomy
For Insertional Achilles Tendinopathy
What It Involves
A Zadek osteotomy is a minimally invasive option for insertional Achilles tendinopathy and Haglund's deformity, performed percutaneously through very small incisions rather than a large open approach. A wedge of bone is removed from the back of the heel bone, allowing the upper portion to hinge downward — reducing the prominence of the back of the heel and changing the angle of the heel bone to reduce impingement load at the Achilles insertion, without needing to detach the tendon itself.
Because it avoids a large open incision and does not require detaching the tendon, this approach carries a lower wound complication rate and a substantially faster recovery than traditional open Haglund resection. It is performed under general or regional anaesthesia as a day surgery case, typically taking 45–75 minutes.
Recovery Timeline
Everyone heals at a different rate — this timeline is a guide.
Weeks 1–2
Non-weight-bearing in a splint or boot, with strict elevation — wound healing is the priority in this early period. The wound is checked and sutures removed at 2 weeks.
Weeks 2–6
Transition into a removable walker boot, with weight-bearing as comfort allows from this point. Physiotherapy can commence from 2 weeks, with gentle range-of-motion and gait work progressing as healing allows.
6 weeks
Most patients transition out of the boot and back into supportive footwear, with an X-ray confirming healing of the osteotomy. Physiotherapy continues with graduated Achilles loading and calf strengthening.
3–5 months
Return to sport and higher-demand activity generally follows over the 2–3 months after the 6-week mark, guided by symptoms and physiotherapy progress, with a final review and discharge once activity has been comfortably resumed.