{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T14:16:00Z","timestamp":1788099360876,"version":"build-2803163510"},"reference-count":30,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Orthopaedics"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Zadek osteotomy (ZO) is a well-established surgical option for insertional Achilles tendinopathy. By modifying the position of the posterior calcaneal tuberosity, ZO may reduce posterosuperior calcaneal prominence, mechanical conflict at the Achilles insertion, and tensile stress on the tendon. Nevertheless, the biomechanical impact of wedge orientation and hinge position\u2014and their relationship with underlying foot morphology\u2014has not been clearly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A weightbearing computed tomography (WBCT)\u2013based virtual simulation was performed on 60 asymptomatic feet, categorized as cavus (n\u2009=\u200920), neutral (n\u2009=\u200920), or planus (n\u2009=\u200920) based on the calcaneal inclination angle. Nine ZO configurations were modeled by combining 3 hinge positions (posterior, A; mid-tuberosity, B; anterior, C) with 3 wedge inclinations. Pre- and post-simulation measurements were compared for calcaneal inclination angle (CIA), talocalcaneal angles, hindfoot moment arm (HMA), hindfoot alignment angle (HAA), Fowler-Philip (FP) angle, X\/Y ratio, and plantar fascia (PF) length.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Wedge inclination showed no significant influence on any variable (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2248 .99). Hinge position, however, markedly affected sagittal alignment. Hinges B and C significantly reduced CIA (hinge B \u22120.5\u00b0 [95% CI \u22120.66\u00b0 to \u22120.4\u00b0]; hinge C \u22122.1\u00b0 [95% CI \u22122.26\u00b0 to \u22121.96\u00b0], both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Hinge B showed the largest reduction in FP angle (\u22127.6\u00b0 [95% CI \u22128.63\u00b0 to \u22126.59\u00b0],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.16) and produced the greatest increase in X\/Y ratio (+0.57 [95% CI +0.46 to +0.68],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.007). In the pre- to post-simulation analysis, HMA increased slightly with hinge B (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.03), and PF length increased only with hinge C (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Subgroup analysis revealed that cavus feet exhibited the greatest sagittal correction, particularly with hinge C.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>ZO significantly affected the Fowler-Philip angle, the primary radiographic outcome, with its overall foot alignment corrective power depending principally on hinge position rather than wedge inclination. These changes occurred predominantly in the sagittal plane while sparing coronal and axial alignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>WBCT-based virtual simulation may help surgeons tailor Zadek osteotomy hinge position to baseline foot morphology and anticipate morphology-specific alignment changes before surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level IV, pre-clinical simulation case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24730114261472894","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:45:06Z","timestamp":1787895906000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Hinge Position and Wedge Orientation in Zadek Osteotomy across Different Foot Morphologies: A Virtual Surgical Simulation Study"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3963-074X","authenticated-orcid":false,"given":"Giammarco","family":"Gardini","sequence":"first","affiliation":[{"name":"Foot and Ankle Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA"},{"name":"Istituto Ortopedico Rizzoli, Bologna, Italy"},{"name":"Alma Mater Studiorum, University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1729-5509","authenticated-orcid":false,"given":"Carla","family":"Carf\u00ec","sequence":"additional","affiliation":[{"name":"Foot and Ankle Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA"},{"name":"Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9033-3946","authenticated-orcid":false,"given":"Wolfram","family":"Gr\u00fcn","sequence":"additional","affiliation":[{"name":"Foot and Ankle Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA"},{"name":"Department of Orthopaedic Surgery, \u00d8stfold Hospital Trust, Gr\u00e5lum, Norway"},{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0821-7939","authenticated-orcid":false,"given":"Jonathan","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Foot and Ankle Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4431-5576","authenticated-orcid":false,"given":"Gustavo Araujo","family":"Nunes","sequence":"additional","affiliation":[{"name":"\u00d3RION Clinic Bras\u00edlia\u2013DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2237-3521","authenticated-orcid":false,"given":"Emily J.","family":"Luo","sequence":"additional","affiliation":[{"name":"Foot and Ankle Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1911-9610","authenticated-orcid":false,"given":"Tommaso","family":"Forin Valvecchi","sequence":"additional","affiliation":[{"name":"ASST Gaetano Pini\u2013CTO, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Zambelli","sequence":"additional","affiliation":[{"name":"Rede Mater Dei de Sa\u00fade, Belo Horizonte, Brazil"},{"name":"Faculdade Ci\u00eancias M\u00e9dicas de Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6037-0685","authenticated-orcid":false,"given":"Cesar","family":"De Cesar Netto","sequence":"additional","affiliation":[{"name":"Foot and Ankle Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06170-x"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-021-02370-0"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2016.04.004"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-023-05155-8"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2017.07.005"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.68B3.3733816"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(39)90877-9"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2023.04.007"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/19386400231162411"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-196547020-00003"},{"issue":"1","key":"e_1_3_3_12_2","first-page":"23","article-title":"Haglund\u2019s deformity and the Keck and Kelly osteotomy: a retrospective analysis","volume":"28","author":"Miller AE","year":"1989","unstructured":"Miller AE, Vogel TA. Haglund\u2019s deformity and the Keck and Kelly osteotomy: a retrospective analysis. J Foot Surg. 1989;28(1):23-29.","journal-title":"J Foot Surg"},{"key":"e_1_3_3_13_2","article-title":"Posterior calcaneal osteotomy: a surgical alternative for chronic retrocalcaneal pain","author":"Martin DE","unstructured":"Martin DE. Posterior calcaneal osteotomy: a surgical alternative for chronic retrocalcaneal pain. Reconstr Surg Foot Leg Update. 1995;95:13.","journal-title":"Reconstr Surg Foot Leg Update"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2020.08.018"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007231181124"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715595696"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007251341890"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2021.02.001"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/24730114221137597"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-95708-x"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2024.05.012"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2018.08.002"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1017\/9781108292399.011"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.2.160077"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2022.12.001"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2018.08.014"},{"key":"e_1_3_3_27_2","doi-asserted-by":"crossref","unstructured":"Cody EA Williamson ER Burket JC Deland JT Ellis SJ. Correlation of talar anatomy and subtalar joint alignment on weightbearing computed tomography with radiographic flatfoot parameters. Foot Ankle Int. 2016;37(8):874-881. Accessed September 3 2025. https:\/\/journals-sagepub-com.ezproxy.unibo.it\/doi\/10.1177\/1071100716646629","DOI":"10.1177\/1071100716646629"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2018.03.001"},{"key":"e_1_3_3_29_2","doi-asserted-by":"crossref","unstructured":"Gould N. Graphing the adult foot and ankle. Foot Ankle. 1982;2(4):213-219. Accessed September 3 2025. https:\/\/journals-sagepub-com.ezproxy.unibo.it\/doi\/10.1177\/107110078200200407","DOI":"10.1177\/107110078200200407"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2017.05.010"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2019.10.011"}],"container-title":["Foot &amp; Ankle Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24730114261472894","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/24730114261472894","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24730114261472894","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T13:49:34Z","timestamp":1788097774000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/24730114261472894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/24730114261472894"],"URL":"https:\/\/doi.org\/10.1177\/24730114261472894","relation":{},"ISSN":["2473-0114","2473-0114"],"issn-type":[{"value":"2473-0114","type":"print"},{"value":"2473-0114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"article-number":"24730114261472894"}}