Zadek Procedure

This prominence can cause irritation and inflammation of the surrounding soft tissues, leading to pain, swelling, and difficulty wearing shoes comfortably. While conservative treatments such as shoe modifications, orthotics, physical therapy, and medications can provide relief for some patients, others may require surgical intervention, particularly when symptoms persist despite non-surgical measures.

One minimally invasive surgical technique commonly employed for Haglund's deformity repair is the Zadek procedure. This approach aims to alleviate symptoms and restore normal anatomy with less tissue disruption and a faster recovery compared to traditional open surgery.

The Zadek procedure typically involves the following steps:

1. Patient Evaluation: Prior to surgery, a comprehensive evaluation including physical examination, imaging studies (X-rays, MRI) and medical history review is conducted to confirm the diagnosis and assess the extent of the deformity.

2. Anesthesia: The procedure is performed under general anesthesia, depending on surgeon's recommendation.

3. Incision: Unlike traditional open surgery, the Zadek procedure utilizes small incisions, usually less than one centimeter in length, strategically placed to access the affected area while minimizing damage to surrounding tissues.

4. Soft Tissue Dissection: Specialized instruments are used to carefully dissect and mobilize the soft tissues, including the Achilles tendon and the retrocalcaneal bursa, away from the bony prominence.

5. Bone Resection: Using precision instruments such as minimally invasive burr, a wedge of bone is removed from the heel bone (Calcaneus), then the opening of the wedge is closed and held firmly with internal pins/screws. This technique moves the prominent portion of the bone away from the Achilles tendon, reliefing the pressure and irritation.

6. Closure: Once the desired correction is achieved, the incisions are closed with sutures, and a sterile dressing is applied to the surgical site.

7. Recovery and Rehabilitation: Following surgery, patients are typically asked to remain non weight brearing for 2-3 week using a set of crutches or a knee scooter. After that initial period of non-weight bearing, full weight is allowed in a protective medical boot for additional 2-3 weeks followed by full weight in regular supportive shoe gear on the affected foot as tolerated. Physical therapy may also be prescribed to facilitate healing, restore strength and range of motion, and prevent complications such as stiffness and muscle atrophy.

The Zadek procedure offers several advantages over traditional open surgery, including reduced postoperative pain, quicker return to normal activities, significantly less scarring, and improved cosmetic outcomes due to smaller incisions. However, as with any surgical intervention, there are potential risks and complications associated with the procedure, such as infection, nerve damage, wound healing problems, hardware failture, non-union of the osteotomy site, and recurrence of symptoms.

In conclusion, the Zadek procedure represents a valuable minimally invasive option for the surgical management of Haglund's deformity, providing effective symptom relief and functional improvement while minimizing morbidity and maximizing patient satisfaction. Close collaboration between patients, surgeons, and rehabilitation specialists is essential to optimize outcomes and ensure a successful recovery.

While this procedure is effective and reproducible, the techniques and outcome of the surgery may vary depending on many different factors. Please be sure to ask all of your questions prior to scheduling your surgery.

Kaveh Panahi, DPM

Board Certified Foot and Ankle Specialist