Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants

Abstract

Background: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24). Results: All radiographic parameters were statistically significantly improved from preoperative to postoperative ( P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site. Conclusion: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship. Level of Evidence: Level IV, case series.

Adult-Acquired Flatfoot Deformity: Combined Talonavicular Arthrodesis and Calcaneal Displacement Osteotomy versus Double Arthrodesis

“…Encouragingly, the angles were shown to be comparable to the post-operative values otherwise obtained in joint-preserving procedures in young adults [16]. The talo-first metatarsal angle on lateral view, the so-called Meary's angle, represents one of the most important radiological criteria regarding the assessment of flatfoot deformity.…”

“…When this study was planned, reviews of other studies focusing on a similar question revealed a comparable number of patients [10,[16][17][18][19]. Statistical analyses were performed using SPSS v. 23 software (IBM Dtl.…”

Outcomes and Safety with Utilization of Metallic Midfoot Wedges in Foot and Ankle Orthopedic Surgery: A Systematic Review of the Literature

“…In total, 11 articles met the eligibility criteria for inclusion in this systematic review from 113 articles initially retrieved from the five databases [11][12][13][14][15][16][17][18][19][20][21]. All 11 articles were initially found on the five databases and no additional articles were included from further reference searches of the included articles.…”

“…For patients with both preoperative and postoperative measurements, patients (n = 88, 19.8% of patients) who received metallic wedges had a frequency-weighted mean preoperative lateral calcaneal pitch angle of 13.6 ± 0.6 degrees and a frequency-weighted mean postoperative lateral calcaneal pitch angle of 19.2 ± 1.6 degrees, whereas patients (n = 27; 6.1% of patients) who received bone allograft wedges had a mean preoperative lateral calcaneal pitch angle of 12.9 degrees and a postoperative lateral calcaneal pitch angle of 25.4 degrees [13]. Furthermore, Fraser et al ( 2019) reported an improvement of 3.1 degrees in patients who received metallic wedges during operative correction of PCFD deformity (n = 31) [13]. For patients with preoperative and postoperative measurements of Meary's angle, patients (n = 139; 31.3% of patients) who received metallic wedges had a frequency-weighted mean preoperative angle of 2.3 ± 15.5 degrees and a frequency-weighted mean postoperative angle of 2.2 ± 4.8 degrees, whereas patients (n = 18; 4.1% of patients) who received bone allograft wedges had a mean preoperative angle of 9.8 degrees and a mean postoperative angle of 1.8 degrees.…”

“…Fraser et al ( 2019) reported that metallic wedges in the medial column of the foot appeared to provide successful radiographical outcomes with similar rates of complications when compared to other common corrective foot and ankle procedures [13]. For patients with both preoperative and postoperative measurements, patients (n = 88, 19.8% of patients) who received metallic wedges had a frequency-weighted mean preoperative lateral calcaneal pitch angle of 13.6 ± 0.6 degrees and a frequency-weighted mean postoperative lateral calcaneal pitch angle of 19.2 ± 1.6 degrees, whereas patients (n = 27; 6.1% of patients) who received bone allograft wedges had a mean preoperative lateral calcaneal pitch angle of 12.9 degrees and a postoperative lateral calcaneal pitch angle of 25.4 degrees [13]. Furthermore, Fraser et al ( 2019) reported an improvement of 3.1 degrees in patients who received metallic wedges during operative correction of PCFD deformity (n = 31) [13].…”