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Short- to Intermediate-Term Radiographic Outcomes Following Cotton Osteotomy.

Brian Au1, Neil B Patel1, Clair N Smith2

  • 1Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons
|January 3, 2022
PubMed
Summary
This summary is machine-generated.

The Cotton osteotomy effectively corrects flatfoot deformities, but shows significant loss of correction after weightbearing begins. Metal grafts may offer better long-term stability for this common foot surgery.

Keywords:
adult acquired flat footcomplicationscottonflatfootmedial cuneiform opening wedge osteotomy

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Area of Science:

  • Orthopedic surgery
  • Foot and ankle reconstruction
  • Podiatric biomechanics

Background:

  • The Cotton osteotomy (medial cuneiform opening wedge osteotomy) is frequently used in flatfoot reconstruction.
  • It addresses forefoot varus and dorsiflexed first ray deformities.

Purpose of the Study:

  • To retrospectively evaluate the short-to-intermediate term outcomes of the Cotton osteotomy.
  • To analyze union and complication rates and radiographic changes.

Main Methods:

  • Retrospective chart review of 71 feet (61 patients) undergoing Cotton osteotomies from 2006-2018.
  • Analysis of union rates, complications, and changes in cuneiform articular angle (CAA) and AP length based on graft size and type.

Main Results:

  • Overall complication rate was 5.6%, with 2.1% nonunion rate in those with >9 months follow-up.
  • A 0.91° change in CAA and 0.70 mm change in AP length per 1 mm graft wedge was observed.
  • Statistically significant loss of correction in CAA and AP length occurred between 6 and 10 weeks post-surgery with weightbearing.

Conclusions:

  • The Cotton osteotomy is a viable procedure for flatfoot correction.
  • A significant loss of radiographic correction is noted after weightbearing initiation.
  • Further research into metal grafts for improved correction maintenance is warranted.