What Is It?
Insertional Achilles Tendinitis is inflammation where the Achilles tendon attaches to the heel bone. It results from repetitive stress, leading to pain, swelling, and sometimes bone spurs. Unlike midportion tendinitis, this affects the lower part of the tendon.
Causes
- Overuse – Running, jumping, or excessive walking
- Tight Calf Muscles – Increases strain on the tendon
- Improper Footwear – Poor arch support or excessive heel drop
- Bone Spurs/Haglund’s Deformity – Extra bone growth irritating the tendon
- Sudden Activity Increase – Rapid changes in exercise intensity
- Poor Foot Mechanics – Flat feet or high arches adding stress
Symptoms
- Pain and stiffness at the back of the heel, worse in the morning
- Swelling and tenderness at the tendon’s insertion point
- Pain with activity, especially uphill walking or running
- Thickened tendon and reduced ankle flexibility
Treatment
Non-Surgical Options
- Rest & Activity Modification – Reduce high-impact activities
- Ice & NSAIDs – Help reduce pain and inflammation
- Stretching & Strengthening – Improves flexibility and tendon health
- Supportive Footwear & Orthotics – Reduces strain on the tendon
- Physical Therapy – Strengthening and mobility exercises
When Is Surgery Needed?
If pain persists after months of conservative treatment, surgery may be required. Dr. Walimire specializes in a minimally invasive Zadek osteotomy for cases which fail conservative treatment.
Minimally Invasive Zadek Osteotomy: A Patient Guide
Introduction
The Zadek osteotomy is a surgical procedure designed to relieve pain and correct deformity in the heel, commonly performed for conditions like Haglund’s deformity, insertional Achilles tendon spurs, Achilles tendinitis, and chronic heel pain. The minimally invasive approach provides several benefits, including faster recovery, smaller incisions, and reduced post-operative discomfort.
Benefits of Minimally Invasive Zadek Osteotomy
- Smaller incisions – Traditional surgery for this condition involves a large incision on the back of the heel which is prone to healing issues. The Achilles tendon is then completely detached from the bone, the spur is removed, and the tendon is reattached. This requires a patient to not place pressure on the foot for 6-8 weeks. The Zadek procedure does not detach the Achilles and allows protected weight-bearing activity after 2 weeks. This minimally invasive procedure also creates less scarring and tissue damage.
- Reduced pain – Minimally invasive techniques lead to a more comfortable recovery.
- Faster healing – Much shorter downtime and faster recovery compared to traditional open surgery.
- Improved mobility – Cutting the bone this way significantly improves ankle range of motion and alleviates Achilles tendon strain, providing long-term relief from chronic heel pain and better function.
- Lower risk of complications – Reduced chance of infection and nerve damage due to the incisions being placed in safer areas.
Procedure Overview
Pre-Surgical Assessment
Your surgeon will conduct a thorough evaluation, which may include X-rays, MRI, or CT scans, to assess the severity of the heel deformity and plan the surgery accordingly.
Surgical Steps
- The procedure is performed under local or general anesthesia.
- A small incision (5-10mm) is made at the side of the heel.
- A precise wedge-shaped cut (osteotomy) is made in the heel bone (calcaneus) to realign it.
- The bone is secured in position with small fixation screws through two more small incisions on the back of the heel.
- The incision is closed with minimal stitches to reduce scarring.
Recovery & Post-Operative Care
First 2 Weeks (Immediate Post-Op)
- Weight-bearing is limited – You will need a walking boot and a knee scooter.
- Pain management – Post-operative pain is mild and manageable with pain relievers.
- Foot elevation is recommended – Helps reduce swelling and speeds up healing.
Weeks 2-6
- Gradual return to walking – Weight-bearing begins slowly with use of the walking boot and a walker. You may return to full weight-bearing in the walking boot as tolerated.
- Physical therapy may begin – Helps improve mobility and strengthen foot muscles.
- Follow-up appointments – X-rays are taken to monitor healing progress.
After 6 Weeks
- Most patients return to normal shoe gear and activities within 6-8 weeks.
- Full recovery and optimal bone healing may take 3-6 months.
- Some mild discomfort may persist initially but improves with therapy and time.
Is This Procedure Right for You?
Ideal Candidates
- Chronic heel pain that has not improved with conservative treatments.
- Structural heel deformities such as spurs affecting mobility and causing pain.
- Conditions such as Haglund’s deformity, heel spurs, or other bony abnormalities.
Not Suitable For:
- Severe osteoporosis (weak bones).
- Uncontrolled diabetes or poor circulation.
- Active infections near the surgical site.
Frequently Asked Questions (FAQs)
How long before I can walk normally?
Most patients walk with a protective boot in 2 weeks and resume normal walking in 6-8 weeks.
Will the screws need to be removed?
In most cases, the screws are permanent and do not cause discomfort, but they can be removed if necessary.
How much pain should I expect?
Pain is usually mild and can be managed with medications and rest.
Can I return to sports?
Yes! After full recovery (3-6 months), most patients may return to high-impact activities.
Contact Your Surgeon
If you’re experiencing chronic heel pain and think the Minimally Invasive Zadek Osteotomy could help, schedule a consultation with Dr. Walimire today!