[Minimally invasive surgery for insertional Achilles tendinopathy : Do Haglund resection, refixation of the Achilles tendon and Zadek osteotomy also work using minimally invasive techniques?]

backgroundInsertional Achilles tendinopathy (IAT), with or without an associated Haglund deformity, represents one of the most common causes of posterior heel pain. Although open surgical procedures provide reliable clinical outcomes, they are associated with prolonged rehabilitation periods and higher complication rates. In recent years, endoscopic and percutaneous techniques have emerged as safe and effective alternatives and should now be considered integral components of the surgical treatment spectrum. THERAPEUTIC OPTIONS: In patients with an isolated Haglund deformity without signs of IAT, percutaneous resection of the Haglund prominence represents an appropriate treatment option. Endoscopic calcaneoplasty is particularly indicated in the presence of a Haglund deformity associated with only mild IAT. In cases of pronounced calcification at the Achilles tendon insertion-irrespective of the presence of a concomitant Haglund deformity-percutaneous Zadek osteotomy offers an effective therapeutic alternative. This procedure allows for significant pain reduction and meaningful functional improvement while maintaining a low complication rate. CHOICE: The choice of surgical technique should be individualized, taking into account the underlying pathology, the extent of Achilles tendon involvement, and patient-specific functional demands.