SLR - August 2018 - Adam J. Oxios
Reference: Boffeli TJ, Schnell KR. Cotton Osteotomy in Flatfoot Reconstruction: A Review of Consecutive Cases. Journal of Foot and Ankle Surgery. 2017 Oct; 56(5):990-995Scientific Literature Review
Reviewed By: Adam J. Oxios, DPM
Residency Program: Westside Regional Medical Center – Plantation FL
Podiatric Relevance: Pes planus is a common deformity seen by the podiatric surgeon. Due to the triplanar nature of the condition, a wide variety of surgical approaches are used to achieve correction. This however has led to difficulty in assessing efficacy of any single procedure used. This study was designed to determine if the Cotton osteotomy is an efficacious and consistent procedure to use in the correction of pes planus deformity.
Methods: This is a retrospective analysis of consecutive patients treated with a Cottons osteotomy. Inclusion criteria were all patients that underwent a Cottons osteotomy as a part of flatfoot reconstructive surgery and were able to perform clinical follow-up at 10 weeks postoperatively. Primary outcomes measured were radiographic incorporation of allograft as well as graft displacement. Meary’s angle was also recorded pre-operatively and at 10 weeks post-operatively.
Results: A total of 32 patients (37 feet) were included in the present study with a mean age of 42 (range 9 to 77) years. Fixation was used in 16 of 37 feet (43.2%). Mean follow-up period was 18 (range 2.5 to 96) months. Meary’s angle improved in all feet with a mean change of -17.2 (range -40 to -7) preoperatively to 0.5 postoperatively (range -12 to 5). This change was statistically significant (p < .01). Incorporation of bone graft was seen in all but one patient who had radiographic healing at 6 months post-op with use of a bone stimulator. No patient required removal of graft or repeat surgery. Two of the thirty-seven feet experienced neuritis which also subsided by 6 months post-op.
Conclusions: The authors conclude that the present retrospective study of consecutive patients demonstrates that the Cotton osteotomy has a very low complication rate. This includes high graft incorporation rates, reliable correction of medial column deformity and does not show evidence of being prone to graft subsidence (even in the absence of any hardware fixation). Additionally, when used in the right patient, this procedure allows for correction of medial column deformity with superb healing predictability while avoiding fusion of any midfoot joints. Limitations of this study are the possible confounding effects of other concomitant procedures.