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A posterolateral incision was made after tourniquet was elevated. The tendon was exposed laterally and the large Haglund's deformity was exposed. It was noted that the chronic tendonitis at the insertion had caused attenuation of the attachment of the tendon and there were great thinning of the fibers that remained attached. This Haglund's deformity was exposed. There was essentially no further insertion for the Achilles tendon. The calcaneal osteotomy was completed and the tendon was released from the calcaneus. All osteophytes were removed. Fluoroscopy was used to verify this. Sequential drill holes were then placed in the calcaneus through a second incision posteromedial. This was enlarged to 6.5 mm. Posterior tibial tendon graft was passed through the calcaneus for the later reconstruction. The tendon was reconstructed through the calcaneus with large suture anchors x2. Platelet-rich plasma matrix was utilized to enhance tendon attachment and was sewn to the graft at this time. With the foot in slight plantar flexion, the tendon was brought back to the calcaneal insertion site. It was then reconstructed with the posterior tibial tendon by placing a slit through the tendon near the musculotendinous junction and bringing the posterior tibial tendon through the Achilles and sewn it back to itself with #2 Ethibond. Overall satisfactory position of the graft was obtained. This was reinforced with #1 Vicryl. All wounds were copiously irrigated. Subcutaneous was closed with 2-0 Vicryl and skin with 4-0 nylon.