The Cotton Osteotomy: A Technical Guide

Yarmel, Daniel; Mote, Gregory A.; Treaster, Amber

doi:10.1053/j.jfas.2009.04.003

Cited by 22 publications

(11 citation statements)

References 14 publications

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“…Cotton osteotomy reduces pressure in lateral column of the foot. 21 Reduction in pressure is thought to result in the alleviation of lateral column pain. Necip et al did cotton osteotomy in only 5 of 21 feet and they did not document lateral column pain, even in those who did not carry out cotton osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Lateral column lengthening augmented by medial split tibialis posterior tendon advancement for the treatment of symptomatic flexible flatfeet

Ahmed

Michael

2019

Int J Res Orthop

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Background: Management of Idiopathic flexible pes planus (IFPP) is debatable. Surgery is rarely indicated for flexible flatfoot. The goal of the surgery should be always to treat symptomatic patients and not to alter the shape of the foot. There are numerous options for surgical treatment in children and adolescents including subtalar arthroereisis or osteotomy with or without soft tissue procedures.Methods: Between June 2013 to December 2017, twenty eight feet in sixteen patients (9 boys, 7 girls) were included in this study. Twelve cases were operated bilaterally, three in the right foot and one in the left side. The mean age of the patients was 8.36±1.704 years (6-12 years). Calcaneal lengthening osteotomy was done with an oscillating saw about 1.5 cm proximal to the calcaneocuboid joint. Usually, 8-10 mm autologous bone graft from iliac crest was sufficient and fixed by K wires. Half of the tibialis posterior tendon after splitting with a periosteal flap from the navicular was then advanced distally until clinical restoration of the medial arch was then performed.Results: Radiographic analysis revealed significant improvements in talo-first metatarsal, calcaneal pitch, talocalcaneal angles in lateral radiographs, and talo-first metatarsal and talonavicular coverage angles in AP radiographs. All patients were evaluated at final follow-up visits. Preoperative mean AOFAS score increased significantly from 64.04±8.867 (range: 50 to75) to 94.11±3.765 (90-100).Conclusions: It is concluded that Evans calcaneal lengthening osteotomy augmented by spilt tibialis posterior tendon advancement is an excellent procedure in the management of IFPP.

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Section: Discussionmentioning

confidence: 99%

Lateral column lengthening augmented by medial split tibialis posterior tendon advancement for the treatment of symptomatic flexible flatfeet

Ahmed

Michael

2019

Int J Res Orthop

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“…Cotton osteotomy decreases pressure in lateral column of the foot. 15 Reduction in pressure is thought to be source of reduced lateral column pain. Although we did not document preoperative or postoperative baropedographic measurements, none of present study patients had lateral column pain, even those who did not undergo Cotton osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment results for flexible flatfoot in adolescents

Yontar¹,

Öğüt

Güven

et al. 2016

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveIdiopathic flexible pes planus (IFPP) is a common foot problem in adolescents and young adults. Hypothesis for the present study was that combination of procedures for IFPP can achieve results in adolescents and young adults that are as good as those seen in adult-acquired pes planovalgus (AAPP) treatment in adults.MethodsA total of 21 feet of 18 patients (10 boys, 8 girls) with mean age of 15.6 years underwent surgical reconstruction for flatfoot deformity. Symptomatic patients who had been unresponsive to conservative treatment were included in study group. Mean follow-up time was 39.2 months. American Orthopedic Foot and Ankle Society (AOFAS) scores were calculated for all patients, and based on final results, all families were asked whether or not they would elect to have the surgery again in same circumstances.ResultsAll procedures were performed by the same surgeon: lateral column calcaneal lengthening osteotomy on 21 feet; percutaneous lengthening or gastrocnemius recession for Achilles tendon on 21 feet; medializing calcaneal osteotomy on 15 feet; flexor digitorum longus tendon transfer on 15 feet; medial cuneiform opening wedge osteotomy on 5 feet, spring ligament plication on 3 feet, and accessory navicular bone excision on 2 feet.Preoperative mean AOFAS score increased significantly from 56.76 to 95.29. All parents stated that they were satisfied with surgery results and would choose to have the same surgery performed again.ConclusionSoft tissue and bony procedures used for reconstruction of AAPP can be used safely for IFPP in adolescents and young adults.Level of clinical evidenceLevel IV, Therapeutic study.

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“…Cotton osteotomy was performed at the midpoint of the medial cuneiform with an oscillating saw blade from dorsal to plantar, keeping the plantar cortex intact. The Hintermann distractor was then used to obtain a 4-6mm opening and checking the alignment between the forefoot and the hindfoot [10]. When the correction was achieved, the homologous bone graft was prepared, or the trabecular titanium wedge of the appropriate size, and positioned in the osteotomy site (Figures 1–3).…”

Section: Methodsmentioning

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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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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The Cotton Osteotomy: A Technical Guide

Cited by 22 publications

References 14 publications

Lateral column lengthening augmented by medial split tibialis posterior tendon advancement for the treatment of symptomatic flexible flatfeet

Lateral column lengthening augmented by medial split tibialis posterior tendon advancement for the treatment of symptomatic flexible flatfeet

Surgical treatment results for flexible flatfoot in adolescents

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

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