Abstract
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.
Highlights
Flatfoot is a common condition in children, adolescents, and some adults
Different surgical techniques including calcaneal osteotomies, subtalar arthrodesis, and tendon transfer have been proposed for the correction of the deformity, but often forefoot varus component should be managed with an adjunctive procedure
Residual forefoot varus can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, known as a Cotton osteotomy [6]
Summary
Flatfoot is a common condition in children, adolescents, and some adults. During first years of life it is usually bilateral and asymptomatic [1]. Different surgical techniques including calcaneal osteotomies, subtalar arthrodesis, and tendon transfer have been proposed for the correction of the deformity, but often forefoot varus component should be managed with an adjunctive procedure. Residual forefoot varus can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, known as a Cotton osteotomy [6]. This procedure is performed by placing an autologous (autograft) or homologous (allograft) wedge-shaped bone graft inside the medial cuneiform [7]. Trabecular titanium wedges have been proposed in substitution of the bone grafts to fill the gap during medial opening wedge osteotomy. The aim of the present study is to compare clinical and radiographic outcomes of patients who underwent Cotton osteotomy with allograft or trabecular titanium wedges
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