The Cole Osteotomy: Maximizing Sagittal Plane Cavus Correction

Abstract

PurposePes cavus can be a debilitating and painful condition requiring surgical intervention. There are many contributing factors to take into account when addressing the deformity. This study documents 21 cases of cavus foot reconstruction using the Cole osteotomy as the primary procedure for feet with an apex of deformity in the midfoot, demonstrating its powerful corrective capabilities. Case study16 Patients (21 Feet) (13 female, 3 male) (Ages 16–55, average age 36.8 years) underwent Cole osteotomy for midfoot driven pes cavus. Secondary procedures include: Hammertoe Arthrodesis (7/21), 1st Metatarsal DFWO (6/21), Plantar Fasciotomy (5/21), Tarsal Tunnel Release (3/21), Posterior Calcaneal Spur Resection (3/21), Ankle Ligament Repair (1/21). All patients had preand post-operative measurements of calcaneal inclination and Meary's angle. ResultsMean pre-op calcaneal inclination angle 17°, mean post-op calcaneal inclination angle 7.75°, for an average of 9.25° of correction. Mean pre-op Meary's angle 23.25°, mean post-op Meary's angle 5.5°, for an average of 17.75° of correction. Analysis and discussionThe Cole midfoot osteotomy is an underutilized procedure, and when done correctly can vastly improve deformity and function. All patients in the series had significant pain relief, and all patients with bilateral deformities returned for the contralateral foot. The procedure demonstrates substantial sagittal plane correction that is difficult to obtain by other means. The full write up includes critical detailed steps articulating vital insights to the success of the procedure.