Abstract
The Cotton osteotomy or opening wedge medial cuneiform osteotomy is a useful adjunctive
flatfoot reconstructive procedure that is commonly performed; however, the outcomes
are rarely reported owing to the adjunctive nature of the procedure. The Cotton procedure
is relatively quick to perform and effectively corrects forefoot varus deformity after
rearfoot fusion or osteotomy to achieve a rectus forefoot to rearfoot relationship.
Proper patient selection is critical because the preoperative findings of medial column
joint instability, concomitant hallux valgus deformity, or degenerative joint disease
of the medial column might be better treated by arthrodesis of the naviculocuneiform
or first tarsometatarsal joints. Procedure indications also include elevatus of the
first ray, which can be a primary deformity in hallux limitus or an iatrogenic deformity
after base wedge osteotomy for hallux valgus. We undertook an institutional review
board-approved retrospective review of 32 consecutive patients (37 feet) who had undergone
Cotton osteotomy as a part of flatfoot reconstruction. All but 1 case (2.7%) had radiographic
evidence of graft incorporation at 10 weeks. No patient experienced graft shifting.
Three complications (8.1%) were identified, including 2 cases with neuritis (5.4%)
and 1 case of delayed union (2.7%) that healed with a bone stimulator at 6 months
postoperatively. Meary's angle improved an average of 17.75°, from −17.24°± 8.00°
to 0.51°± 3.81°, and this change was statistically significant (p < .01). The present retrospective series highlights our experience with the use of
the Cotton osteotomy as an adjunctive procedure in flatfoot reconstructive surgery.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: July 06, 2017
Footnotes
Financial Disclosure: None reported.
Conflict of interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
