Osteotomies of the ankle and foot

Abstract

Wedge excision of the lower femur to correct knee flexion contracture, pioneered by Barton of Philadelphia in 1837,’ signalled the introduction of a further operative technique fundamental to surgery of the locomotor system. Unlike subcutaneous tenotomy and joint excision, the acceptance of osteotomy was delayed for several decades, due to associated interoperative bone infection, morbidity and death. Nevertheless in 1853, Mayer of Wurzburg successfully corrected several knock-knee deformities by lower femoral and upper tibia1 osteotomies.’ It was left to Macewen of Glasgow to make osteotomy safe and routine, from 1878, by a rigorous antiseptic approach.3 Application to the foot was a later development, perhaps because of its particular bony anatomy and lack of angular deformity at any one site. Most foot osteotomies achieve correction by opening or closing a bony wedge, with the exception of linear overlap through the metatarsal shafts.