The corrective power of the Cotton osteotomy

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Summary The Cotton osteotomy is a plantarflexion osteotomy of the medial cuneiform, which is typically utilized in the reconstruction of adult acquired pes planus, posterior tibialis tendon dysfunction stage II (Johnson and Strom), and forefoot varus. The purpose of this paper is to give an estimate of the angular correction in the sagittal plane for each millimeter of bone graft used in the Cotton osteotomy using 20 cadaveric specimens. We have demonstrated that a surgeon will gain roughly 1.9 degrees of plantar flexion of the medial column for every one millimeter graft inserted into the medial cuneiform. While we have not established the amount of correction that should be done, the effect of increasing the wedge size has been demonstrated and may be helpful to surgeons when performing the Cotton osteotomy.