PURPOSE: Dorsal closing wedge calcaneal osteotomy (DCWCO) is indicated in patients with insertional tendinopathy of the calcaneal (Achilles) tendon. The Chauveaus-Liet's (CL) angle is represented by the difference between the angle of verticalization (α) and morphological angle (β) of the calcaneus (CL angle = α - β). The purpose of the study was to assess whether the DCWCO affects the Chauveaus-Liet's angle. METHODS: The study included 12 patients indicated to DCWCO. Three directions of close wedge osteotomy were designed for each patient-horizontal, vertical and in the middle type of osteotomy and a virtual osteotomy was created in each of them in the ABAQUS system in cooperation with Czech Technical University. The most used directions of osteotomy according to the available literature were used. We evaluated α and β angles before and after osteotomy, changes of the length plantar aponeurosis and the elevation of distal insertional point of the calcaneal tendon. The changes of grades, median and standard deviation were observed. RESULTS: The change of the alfa angle was dependent on the direction of the osteotomy and the change of the beta angle was affected by the size of the osteotomy. The greatest elevation of the distal insertional point of the calcaneal tendon occurred in the horizontal type of the osteotomy. CONCLUSION: Our study shows that the more we want to reduce the tension in the calcaneal tendon, the more we have to perform an osteotomy horizontally. This study could serve as a preoperative guide for osteotomy planning.

1st Department of Orthopaedics 1st Faculty of Medicine Charles University and Motol University Hospital 5 Úvalu 84 150 06 Prague 5 Czech Republic

Department of Anatomy 2nd Faculty of Medicine Charles University 5 Úvalu 84 150 06 Prague 5 Czech Republic

Department of Mechanics Bioemchanics and Mechatronics Faculty of Mechanical Engineering Czech Technical University Prague Technická 4 166 07 Prague 6 Czech Republic

See more in PubMed

Erroi D, Sigona M, Suarez T, Trischitta D, Pavan A, Vulpiani MC, Vetrano M. Conservative treatment for Insertional Achilles Tendinopathy: platelet-rich plasma and focused shock waves. A retrospective study. Muscles Ligaments Tendons J. 2017;7(1):98–106. doi: 10.11138/mltj/2017.7.1.098. PubMed DOI PMC

Notarnicola A, Maccagnano G, Tafuri S, Forcignano MI, Panella A, Moret B. CHELT therapy in the treatment of chronic insertional Achilles tendinopathy. Lasers Med Sci. 2014;29(3):1217–1225. doi: 10.1007/s10103-013-1510-3. PubMed DOI

Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 2010;31(10):933–939. doi: 10.3113/FAI.2010.0933. PubMed DOI

Lui TH, Lo CY, Siu YC. Minimally invasive and endoscopic treatment of haglund syndrome. Foot Ankle Clin. 2019;24(3):515–531. doi: 10.1016/j.fcl.2019.04.006. PubMed DOI

Schoolfield BL. An operation for the cure of flatfoot. Ann Surg. 1939;110(3):437–446. doi: 10.1097/00000658-193909000-00009. PubMed DOI PMC

Taylor GJ. Prominence of the calcaneus: Is operation justified? J Bone Jt Surg Br. 1986;68(3):467–470. doi: 10.1302/0301-620X.68B3.3733816. PubMed DOI

Georgiannos D, Lampridis V, Vasiliadis A, Bisbinas I. Treatment of insertional Achilles pathology with dorsal wedge calcaneal osteotomy in athletes. Foot Ankle Int. 2017;38(4):381–387. doi: 10.1177/1071100716681139. PubMed DOI

Maynou C, Mestdagh H, Dubois HH, Petroff E, Elise S. Is calcaneal osteotomy justified in Haglund's disease?. Rev Chir Orthop Reparatrice Appar Mot. 1998;84(8):734–738. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10192124. PubMed

Tourne Y, Baray AL, Barthelemy R, Moroney P. Contribution of a new radiologic calcaneal measurement to the treatment decision tree in Haglund syndrome. Orthop Traumatol Surg Res. 2018;104(8):1215–1219. doi: 10.1016/j.otsr.2018.08.014. PubMed DOI

Jowett CR, Rodda D, Amin A, Bradshaw A, Bedi HS. Minimally invasive calcaneal osteotomy: a cadaveric and clinical evaluation. Foot Ankle Surg. 2016;22(4):244–247. doi: 10.1016/j.fas.2015.11.001. PubMed DOI

Boffeli TJ, Peterson MC. The keck and kelly wedge calcaneal osteotomy for Haglund's deformity: a technique for reproducible results. J Foot Ankle Surg. 2012;51(3):398–401. doi: 10.1053/j.jfas.2012.03.002. PubMed DOI

Nordio A, Chan JJ, Guzman JZ, Hasija R, Vulcano E. Percutaneous Zadek osteotomy for the treatment of insertional Achilles tendinopathy. Foot Ankle Surg. 2020;26(7):818–821. doi: 10.1016/j.fas.2019.10.011. PubMed DOI

Vernois J, Redfern D, Ferraz L, Laborde J. Minimally invasive surgery osteotomy of the hindfoot. Clin Podiatr Med Surg. 2015;32(3):419–434. doi: 10.1016/j.cpm.2015.03.008. PubMed DOI

Heneghan MA, Pavlov H. The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications. Clin Orthop Relat Res. 1984; (187): 228–234. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6744723. PubMed

Husson JL, De Korvin B, Polard JL, Attali JY, Duvauferrier R. Study of the correlation between magnetic resonance imaging and surgery in the diagnosis of chronic Achilles tendinopathies. Acta Orthop Belg. 1994;60(4): 408–412. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7847091. PubMed

Ruch JA. Haglund's disease. J Am Podiatry Assoc. 1974;64(12):1000–1003. doi: 10.7547/87507315-64-12-1000. PubMed DOI

DiGiovanni JE, Smith SD. Normal biomechanics of the adult rearfoot: a radiographic analysis. J Am Podiatry Assoc. 1976;66(11):812–824. doi: 10.7547/87507315-66-11-812. PubMed DOI

Ge Z, Ma L, Tang H, Yang M, Yang A, Yuan C, Chen W. Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome. J Orthop Surg Res. 2020;15(1):168. doi: 10.1186/s13018-020-01687-6. PubMed DOI PMC

Tourne Y, Baray AL, Barthelemy R, Karhao T, Moroney P. The Zadek calcaneal osteotomy in Haglund's syndrome of the heel: clinical results and a radiographic analysis to explain its efficacy. Foot Ankle Surg. 2021 doi: 10.1016/j.fas.2021.02.001. PubMed DOI

McAlister JE, Hyer CF. Safety of achilles detachment and reattachment using a standard midline approach to insertional enthesophytes. J Foot Ankle Surg. 2015;54(2):214–219. doi: 10.1053/j.jfas.2014.12.009. PubMed DOI

Phisitkul P. Endoscopic surgery of the Achilles tendon. Curr Rev Musculoskelet Med. 2012;5(2):156–163. doi: 10.1007/s12178-012-9115-1. PubMed DOI PMC

Ortmann FW, McBryde AM. Endoscopic bony and soft-tissue decompression of the retrocalcaneal space for the treatment of Haglund deformity and retrocalcaneal bursitis. Foot Ankle Int. 2007;28(2):149–153. doi: 10.3113/FAI.2007.0149. PubMed DOI

Vega J, Baduell A, Malagelada F, Allmendinger J, Dalmau-Pastor M. Endoscopic Achilles tendon augmentation with suture anchors after calcaneal exostectomy in haglund syndrome. Foot Ankle Int. 2018;39(5):551–559. doi: 10.1177/1071100717750888. PubMed DOI