Surgical management of forefoot supinatus in flexible flatfoot deformity

In the past, many surgical procedures have been advocated for correction of painful flexible flatfoot deformity. More recent opinions advocate the concept that no one procedure is appropriate to all flatfoot deformities. Individual assessment is now necessary to determine the predominant component deformities. One such component deformity frequently encountered is forefoot supinatus. The authors review the more commonly performed procedures for this problem, as well as their preferred approach of the modified Hoke arthrodesis or Cotton osteotomy. The choice of procedure is dictated by whether the first metatarsal or longitudinal axis subluxation predominates.