Osteotomy in the pediatric foot

Osteotomies are the mainstays of treatment of foot deformities in patients from age 5 to skeletal maturity. A careful biomechanical assessment allows the clinician to evaluate the deformities in the frontal, sagittal, and transverse planes of the body. It also allows the clinician to relate deformities found at the ankle, hindfoot, forefoot, and midfoot to one another and to formulate a cohesive plan of treatment. Presentations with multiple deformities in different parts of the foot and ankle are common. These deformities are not always bony. A classic example is the gastrocnemius contracture in the symptomatic flatfoot. Procedures should be planned to correct all aspects of the deformity at a single sitting if possible.