Radiographic analysis of an opening wedge osteotomy of the medial cuneiform

Forefoot varus deformity and medial column instability can develop or be present in association with ankle and hindfoot pathology. This study aimed to confirm the utility of medial cuneiform opening wedge osteotomy as part of hindfoot and ankle deformity correction.

Patients requiring operative management of flatfoot deformity between January 2002 and December 2007 were prospectively entered in a database. We selected all patients who underwent medial cuneiform opening wedge osteotomy. One hundred and one feet in 86 patients of mean age 36 (range, 9 to 80) years were evaluated. Eighty-one feet had adequate radiographic imaging for assessment. Concomitant procedures were performed. We measured standardized, validated radiographic parameters on pre- and postoperative weightbearing foot radiographs. Variables including concomitant surgical procedures, osteotomy union, malunion, and midfoot arthritis were noted.

The mean lateral talus-first metatarsal angle improved from 23 degrees to 1 degrees (p < 0.001); mean medial cuneiform to floor distance improved from 20 mm to 34 mm (p < 0.001); mean talar declination angle improved from 39 degrees to 27 degrees (p < 0.001); mean calcaneal-talar angle improved from 64 degrees to 55 degrees (p < 0.001); calcaneal pitch angle improved from 14 degrees to 23 degrees (p < 0.001); mean first metatarsal declination angle improved from 17 degrees to 26 degrees (p < 0.001); mean talonavicular coverage angle improved from 45 degrees to 18 degrees (p < 0.001); and mean anteroposterior talus-first metatarsal angle improved from 19 degrees to 0 degrees (p < 0.001).

Radiographical analysis showed that medial cuneiform opening wedge osteotomy combined with other corrective procedures corrected forefoot varus, elevated first metatarsal and medial column instability radiographic parameters that are most commonly associated with flatfoot deformity.