A Plantar Closing Wedge Osteotomy of the Medial Cuneiform for Residual Forefoot Supination in Flatfoot Reconstruction

Ling, Jeffrey S.; Ross, Keir A.; Hannon, Charlie P.; Egan, Christopher J.; Smyth, Niall A.; Hogan, MaCalus V.; Kennedy, John G.

doi:10.1177/1071100713487726

Cited by 28 publications

(13 citation statements)

References 15 publications

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“…The high rate of consolidation depends on the blood supply of the medial cuneiform, provided by the medial tarsal artery, branch of the dorsal pedis artery [18]. Ling et al tried to simplify the surgical technique by performing a wedge osteotomy with plantar subtraction ("reverse Cotton osteotomy") avoiding the surgical step of the bone graft [19]. Although the surgical technique included the medial incision, which may damage the medial tarsal artery, the results obtained in 10 patients reported a 100% osteotomy healing rate and an improvement of 10° of the MA.…”

Section: Discussionmentioning

confidence: 99%

“…Ling et al reported in a small case series 1 case of hardware complication after a “reverse Cotton Osteotomy: the patient required hardware removal, tenosynovectomy at Henry's knot, and medial plantar neurolysis, resulting in good relief of symptoms. In this study, one patient in the TTW group required revision surgery, while two patients in the HBG group underwent revisional surgery [19].…”

Section: Discussionmentioning

confidence: 99%

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Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

Romeo

Bianchi

Cerbone

et al. 2019

BioMed Research International

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Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

Romeo

Bianchi

Cerbone

et al. 2019

BioMed Research International

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“…A plantar-based closing wedge osteotomy of the medial cuneiform has been suggested as an alternative to the Cotton opening wedge osteotomy for correcting forefoot supination deformity. 1,7,13,14 This osteotomy, in conjunction with a calcaneal lengthening osteotomy, was introduced by Anderson and Fowler in 1984 for correction of pes planus deformity. 13 In 1995, Mosca reported on the efficacy of the calcaneal lengthening osteotomy for correction of hindfoot valgus in flatfoot and skewfoot deformities.…”

Section: Discussionmentioning

confidence: 99%

The Biplanar Effect of the Medial Cuneiform Osteotomy

Mortimer

Bouchard

Acosta

et al. 2019

Foot & Ankle Specialist

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Background. The “foot-CORA” (center of rotation of angulation) method confirms the medial cuneiform as the site of deformity in most forefoot/midfoot deformities and is therefore the ideal location to correct those deformities. It has been consistently observed intraoperatively by the senior author that there is a secondary, unintentional deformity created in the transverse plane when dorsiflexion and plantar flexion osteotomies of the medial cuneiform are performed to correct pronation and supination forefoot deformities, respectively. These effects may not be desirable. This biplanar effect of medial cuneiform osteotomies has been observed but not studied. The purpose of this study was to perform the 4 commonly used medial cuneiform osteotomy techniques on cadaveric feet to demonstrate their biplanar effects. Methods. Four formaldehyde preserved cadaveric feet were used to perform 4 techniques of medial cuneiform osteotomy: dorsiflexion plantar-based opening wedge, plantar flexion dorsal-based opening wedge, dorsiflexion dorsal-based closing wedge, and plantar flexion plantar-based closing wedge. Photographs and fluoroscopy were used to assess the angular changes in the sagittal and transverse planes. Angular measurements were made using OsiriX software on fluoroscopic images. Results. The medial cuneiform opening wedge osteotomies produced midfoot abduction in addition to the desired dorsiflexion and plantar flexion. The medial cuneiform closing wedge osteotomies produced midfoot adduction in addition to the desired dorsiflexion and plantar flexion. Conclusion. We confirm that intentional sagittal uniplanar osteotomies of the medial cuneiform create obligate biplanar effects. This is likely a result of tethering by ligaments and the joint capsules on the lateral border of the medial cuneiform. The obligate transverse plane effect can be used to one’s advantage or result in an undesired effect if not considered during surgical planning and execution. We propose a simple treatment algorithm for selecting the appropriate medial cuneiform osteotomy for forefoot/midfoot deformities. Levels of Evidence: Level V

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“…A plantar closing wedge osteotomy of the medial cuneiform (Cotton osteotomy) for treatment of a tibialis posterior tendon dysfunction required a reflection of approximately 20% of the tibialis anterior insertion on the plantar side in order to perform the osteotomy. 13 A biomechanics study demonstrated potential tendon healing in partial tendon injuries, but the injuries that occurred at the osteotendinous junction, a complex transitional area between the bone and the tendon, was the weakest area and required a long time to heal, which resulted in inferior mechanical properties. 12,23 Although this study had a high intraclass correlation coefficient for intraobserver and interobserver reliability of measurements, one limitation was the determination of the tendon attachment size.…”

Section: Discussionmentioning

confidence: 99%

Appropriate Area for Operative Procedures Near Tibialis Anterior Tendon Insertion: A Cadaveric Study

Jarusriwanna

Chuckpaiwong

2018

Foot Ankle Int.

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A Plantar Closing Wedge Osteotomy of the Medial Cuneiform for Residual Forefoot Supination in Flatfoot Reconstruction

Abstract: Level IV, retrospective case series.

Cited by 28 publications

References 15 publications

Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

The Biplanar Effect of the Medial Cuneiform Osteotomy

Appropriate Area for Operative Procedures Near Tibialis Anterior Tendon Insertion: A Cadaveric Study

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