scholarly journals Surgical Anatomy of the Medial Cuneiform (Cotton) Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988534
Author(s):  
Baofu Wei ◽  
Brian C. Lau ◽  
Annunziato Amendola
Keyword(s):  
Tilt Angle ◽  
Tibialis Anterior ◽  
Articular Surface ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Small Branch ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
Oblique Incision ◽  
Distal Articular Surface

Background: The Cotton osteotomy, or dorsal-opening wedge osteotomy of the medial cuneiform (MC), is used to address medial column alignment to restore the static-triangle of support. There are many described techniques regarding the incision and osteotomy. Successful completion of the osteotomy requires knowledge of the anatomy, particularly the location of the medial dorsal cutaneous nerve (MDCN). This study describes the relationship between MDCN, tibialis anterior, extensor-hallucis-longus tendon, and ligamentous attachments to the MC. A technique to determine a safe location for the osteotomy is also described. Methods: Twelve fresh-frozen adult foot specimens were used for this study (7 male and 5 female). The MDCN and its branches were dissected and its relationship with the MC was documented. Osteotomy tilt angle and relationship to structures around the MC were measured. Results: MDCN traveled medially and distally over the dorsum of the MC, and a small branch to the MC was observed. The tilt angle was 80.1 ±1.4 degrees. There was no significant difference between the distance from the distal-articular surface to the midline of the cuneiform and to the interosseous ligament ( P = .69), or between the distance from the distal-articular surface to the second tarsometatarsal joint and to the origin of the Lisfranc ligament ( P = .12). Conclusions: The dorsal-medial-oblique incision effectively protected MDCN and the MC. We believe the osteotomy should be performed in the safe zone to maintain the stability of the opening wedge. Clinical relevance: The dorsal-medial-oblique incision could reduce the risk of injury to the MDCN and the tibialis-anterior tendon.

scholarly journals Effect of the additional first ray osteotomy on hindfoot alignment after calcaneal osteotomy for the correction of mild-to-moderate adult type pes plano-valgus

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668474
Author(s):  
Jun Young Choi ◽  
Seong Mu Cha ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Adult Type ◽  
Hindfoot Alignment ◽  
Calcaneal Osteotomy ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
First Ray ◽  
Pes Plano Valgus

Purpose: To determine the effect of the additional first ray osteotomy on hindfoot alignment for the correction of pes plano-valgus. Methods: Data obtained from 37 consecutive patients recruited from 2006 to 2014 who underwent medial displacement calcaneal osteotomy (MDCO) alone (group H) or MDCO followed by medial cuneiform opening wedge osteotomy (MCOWO) (group HF) with a minimum 1-year follow-up were reviewed retrospectively. The mean follow-up periods were 34 and 32 months. Results: Degree of decrease of Talonavicular coverage angle (TNCA) via surgery or postoperative TNCA on standing foot AP radiographs were not significantly different between group H and HF ( p = 0.287). The calcaneal pitch angle and medial cuneiform height on the standing foot lateral radiographs was significantly increased after operation in group HF ( p = 0.01), there was a significant difference with group H as well ( p = 0.033). In group HF, the Meary’s angle was significantly decreased after operation, a significant difference compared to group H ( p = 0.009). Hindfoot alignment angle on the hindfoot alignment view was decreased after operation in both groups but was not significantly different between both groups ( p = 0.410). Hindfoot alignment ratio was also increased after the operation in both groups, but was not different between two groups ( p = 0.783). Conclusion: The additional first ray osteotomy using MCOWO had no correctional power for hindfoot correction, although it caused improvement in some radiographic parameters.

scholarly journals Joint-Preserving Surgery for Hyperextension Deformity of the Hallux Interphalangeal Joint in a Patient with Rheumatoid Arthritis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Takumi Matsumoto ◽  
Yuki Shimizu ◽  
Song Ho Chang ◽  
Taro Kasai ◽  
Jun Hirose ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Joint Preserving Surgery ◽  
Medial Cuneiform

Interphalangeal hyperextension is one of the major hallux deformities in patients with rheumatoid arthritis; however, there is yet no established surgical method for this deformity. We here present the case of a 69-year-old female patient with rheumatoid arthritis who developed hallux interphalangeal hyperextension and painful callosity on the plantar hallux accompanied by limited dorsiflexion at the metatarsophalangeal joint. Lateral weight-bearing radiograph of the foot revealed misalignment of the medial column and hallux, including a collapsed medial arch, elevated first metatarsal, plantar flexion and deviation of the proximal phalanx, and hyperextension of the distal phalanx. The foot was successfully treated and became symptom-free with opening wedge osteotomy of the medial cuneiform, plantar and proximal translation of the metatarsal head, and tenotomy of the extensor hallucis longus. This case suggests that reconstruction of the sagittal alignment of the medial column and hallux through a combination of osteotomy and soft tissue intervention could be an optional treatment for interphalangeal hyperextension.

Radiographic Assessment of Medial Cuneiform Opening Wedge Osteotomy for Flatfoot Correction

2012 ◽  
Vol 33 (6) ◽  
pp. 498-500 ◽  
Author(s):  
Deborah Castaneda ◽  
David B. Thordarson ◽  
Timothy P. Charlton
Keyword(s):  
Wedge Osteotomy ◽  
Radiographic Assessment ◽  
Opening Wedge ◽  
Medial Cuneiform

Radiographic Assessment of First Tarsometatarsal Joint Shape and Orientation

2019 ◽  
Vol 40 (12) ◽  
pp. 1438-1446
Author(s):  
Kimberly Koury ◽  
Jackson R. Staggers ◽  
Martim C. Pinto ◽  
Alexandre L. Godoy-Santos ◽  
Niall A. Smyth ◽  
...  
Keyword(s):  
Image Quality ◽  
Articular Surface ◽  
Anatomical Variations ◽  
Mean Value ◽  
Radiographic Evaluation ◽  
Predisposing Factor ◽  
Medial Cuneiform ◽  
Fresh Frozen ◽  
Operative Planning ◽  
Distal Articular Surface

Background: Hypermobility within the first tarsometatarsal (TMT) joint is a predisposing factor for hallux valgus. The purpose of this study was to assess whether the shape and angulation of the first TMT joint are affected by the positioning of the foot in radiographs. Methods: Ten adult above-knee fresh-frozen cadaveric specimens were placed into a radiolucent apparatus that allowed controlled angulation of each foot at 0, 5, 10, 15, and 20 degrees in dorsiflexion, plantarflexion, inversion, and eversion. For each specimen, the first TMT joint angle (1TMTJA), shape of the distal articular surface of the medial cuneiform (flat or curved), and image quality of the first TMT joint were measured. Results: The mean value for 1TMTJA was 22.9 degrees (95% confidence interval [CI] 21.9-24). Individual anatomical variations of the specimens as well as the different angulations due to foot positioning significantly influenced the 1TMTJA (both P < .001). Joints that were found to have a flat configuration showed significantly increased 1TMTJA on average when compared to the ones with curved articular surface, 25.9 (95% CI 24.4-27.4) and 20.8 degrees (95% CI 19.5-22.0) ( P < .001), respectively. Image quality for visualization of the first TMT joint was progressively better for increased angles of dorsiflexion and inversion. Conclusion: The shape and angulation of the first TMT joint on radiographic evaluation are affected by the positioning of the foot. Clinical Relevance: Clinical usefulness of these radiographic characteristics is limited and should not influence operative planning in patients with possible instability of the first TMT joint.

Proximal First Metatarsal Opening Wedge Osteotomy with a Low Profile Plate

2009 ◽  
Vol 30 (9) ◽  
pp. 865-872 ◽  
Author(s):  
Paul S. Shurnas ◽  
Troy S. Watson ◽  
Timothy W. Crislip
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Vas Score ◽  
Hallux Varus ◽  
Hallux Valgus Deformity ◽  
Significant Difference ◽  
The Mean

Background: Many surgical procedures have been described for the correction of metatarsus primus varus associated with hallux valgus deformity. The purpose of this study was to present the results of the proximal metatarsal opening wedge (PMOW) osteotomy using the Arthrex LPS® first metatarsal system. Materials and Methods: Eighty-four patients (90 feet) underwent PMOW osteotomy with distal bunionectomy. There were 78 patients (93%) and 84 (93%) feet available for followup. Mean followup was 2.4 (range, 2.0 to 3.2) years from the time of the index surgery. Pre- and postoperative clinical examination, level of activity, patient derived subjective satisfaction score, radiographic measurements, and visual analogue scale (VAS) score for pain were obtained and evaluated retrospectively. Results: The mean preoperative VAS score was 5.9 (± 2.2), compared with a mean postoperative score of 0.5 (± 0.8). The mean 1–2 IMA preoperatively was 14.5 (±3.3) degrees, compared with postoperative measurements of 4.6 (± 2.8) degrees. The mean hallux valgus angle (HVA) improved from a mean of 30 (range, 22 to 64) degrees preoperatively to 10 (range, −15 to +18) degrees. The mean time to radiographic union was 5.9 (range, 4 to 14) weeks. There was one nonunion, one delayed union, mild hallux varus in two patients, severe hallux varus in two patients, recurrent hallux valgus in three patients (including the nonunion) and no instances of plate failure there was no significant difference in mean preoperative (74.8 degrees ± 11) compared to postoperative (67.9 degrees ± 10) total MTP joint range of motion. Ninety percent of patients reported good to excellent subjective results after the index surgery. Conclusion: We believe PMOW osteotomy was near ideal in terms of reliable, predictable correction and healing. Length of the first metatarsal was maintained and patients ambulated safely in a CAM walking boot immediately after surgery. We believe a first web space release may result in hallux varus and increased distal metatarsal articular angle (DMAA) was associated with hallux valgus recurrence. Level of Evidence: IV, Retrospective Case Series

The Effect of Medial Opening Wedge Proximal Tibial Osteotomy on Patellofemoral Contact

2012 ◽  
Vol 41 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Pooya Javidan ◽  
Gregory J. Adamson ◽  
Jennifer R. Miller ◽  
Pierre Durand ◽  
Patrick A. Dawson ◽  
...  
Keyword(s):  
Contact Forces ◽  
Wedge Osteotomy ◽  
Materials Testing ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Proximal Tibial Osteotomy ◽  
Pressure Sensitive ◽  
Sensitive Film ◽  
Significant Difference ◽  
Pressure Sensitive Film

Background: It has been suggested that patellofemoral contact pressures and contact forces may be altered secondary to an opening wedge high tibial osteotomy, yet few data are available that quantify the effect of varying degrees of medial opening wedge osteotomy on the patellofemoral joint contact characteristics. Hypothesis: Opening wedge medial proximal tibial osteotomy will increase patellofemoral contact force and pressure. Study Design: Controlled laboratory study. Methods: Nine human cadaver knees were used. Pressure-sensitive film was placed in the suprapatellar pouch, leaving the patellar tendon and medial and lateral retinacula intact. The quadriceps tendon was attached to a materials testing machine along the axis of the femur, whereby a pulley mechanism generated 950 N of force. Patellofemoral contact characteristics were measured with pressure-sensitive film at 30°, 60°, 90°, and 120° of flexion for the native knee and after subsequent 10-mm and 15-mm medial opening wedge proximal tibial osteotomies. The film was analyzed with imaging software. Results: There was a statistically significant increase ( P < .05) in mean contact pressure at 30° and 120° between the 10-mm osteotomy and native knee and across all flexion angles between the 15-mm osteotomy and native knee. Furthermore, a significant difference was seen in peak pressures when native knees were compared with 10-mm and 15-mm opening wedge osteotomies at all flexion angles. Conclusion: There was a significant increase in patellofemoral pressures at varying degrees of knee flexion after medial opening wedge proximal tibial osteotomies of only 10 mm; a larger osteotomy resulted in a greater increase. Clinical Relevance: When performing a medial opening wedge proximal tibial osteotomy, the surgeon should consider the negative effects of increased patellofemoral peak pressure.

Ligamentous Lisfranc Joint Injuries: A Biomechanical Comparison of Dorsal Plate and Transarticular Screw Fixation

2005 ◽  
Vol 26 (6) ◽  
pp. 462-473 ◽  
Author(s):  
Frank G. Alberta ◽  
Michael S. Aronow ◽  
Mauricio Barrero ◽  
Vilmaris Diaz-Doran ◽  
Raymond J. Sullivan ◽  
...  
Keyword(s):  
Articular Surface ◽  
Surface Damage ◽  
Current Treatment ◽  
Dorsal Plate ◽  
Rigid Fixation ◽  
First Metatarsal ◽  
Medial Cuneiform ◽  
Second Metatarsal ◽  
Significant Difference ◽  
Fresh Frozen

Background: The current treatment of displaced ligamentous injuries of the tarsometatarsal (TMT) joints is open reduction and rigid fixation using transarticular screws. This technique causes further articular surface damage that theoretically may increase the risk of arthritis. Should the screws break, hardware removal is difficult. An alternative method that avoids these potential complications is rigid fixation using dorsal plates. Methods: The displacement between the first metatarsal and medial cuneiform, the second metatarsal and intermediate cuneiform, the first and second metatarsal bases, and the medial cuneiform and second metatarsal base were measured in 10 matched pairs of fresh-frozen cadaver lower extremities in the unloaded and loaded condition. After sectioning the Lisfranc and TMT joint ligaments, measurements were repeated in the loaded condition. The first and second TMT joints of the right feet were fixed with transarticular 3.5-mm cortical screws while those of the left feet with were fixed with dorsal 2.7-mm 1/4 tubular plates. Measurements were then repeated in the unloaded and loaded condition. Results: After ligament sectioning, significantly increased first and second TMT joint subluxation with loading was seen. No significant difference was noted with direct comparison between plates and screws with respect to ability to realign the first and second TMT joints and to maintain TMT joint alignment during loading. The amount of articular surface destruction caused by one 3.5-mm screw was 2.0 ± 0.7% for the medial cuneiform, 2.6 ± 0.5% for the first metatarsal, 3.6 ± 1.2% for the intermediate cuneiform, and 3.6 ± 1.0% for the second metatarsal. Conclusions: The model reliably produced displacement of the first and second TMT joints consistent with a ligamentous Lisfranc injury. Transarticular screws and dorsal plates showed similar ability to reduce the first and second TMT joints after TMT and Lisfranc ligament transection and to resist TMT joint displacement with weightbearing load. Clinical relevance: Dorsal plating may be an alternative to transarticular screws in the treatment of displaced Lisfranc injuries.

Titrating the Amount of Bony Correction in Progressive Collapsing Foot Deformity

2020 ◽  
Vol 41 (10) ◽  
pp. 1292-1295
Author(s):  
Scott J. Ellis ◽  
Jeffrey E. Johnson ◽  
Jonathan Day ◽  
Cesar de Cesar Netto ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Reconstructive Surgery ◽  
Wedge Osteotomy ◽  
Foot Deformity ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
Lateral Column ◽  
Medial Cuneiform ◽  
Lateral Column Lengthening ◽  
Typical Range ◽  
Consensus Expert

Recommendation: There is evidence indicating that the amount of bony correction performed in the setting of progressive collapsing foot deformity reconstructive surgery can be titrated within a recommended range for a variety of procedures. The typical range when performing a medial displacement calcaneal osteotomy should be 7 to 15 mm of medialization of the tuberosity. The typical range when performing an Evans lateral column lengthening should be 5 to 10 mm of a laterally based wedge in the anterior calcaneus. The typical range when performing a plantarflexion opening wedge osteotomy of the medial cuneiform (Cotton) osteotomy should be 5 to 10 mm of a dorsal wedge. Level of Evidence: Level V, consensus, expert opinion.

scholarly journals Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Giovanni Romeo ◽  
Alberto Bianchi ◽  
Vincenzo Cerbone ◽  
Matteo Maria Parrini ◽  
Francesco Malerba ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Bone Allograft ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Metallic Implant ◽  
Radiographic Outcomes ◽  
Clinical Scores ◽  
Medial Cuneiform ◽  
Forefoot Varus

Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.

scholarly journals Medial Cuneiform Opening-Wedge Osteotomy for the Treatment of Hallux Valgus

2019 ◽  
Vol 4 (1) ◽  
pp. 247301141881331
Author(s):  
Jason S. Ahuero ◽  
John S. Kirchner ◽  
Paul M. Ryan
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Low Profile ◽  
Medial Cuneiform ◽  
The Mean ◽  
Wedge Plate

Background: While proximal first metatarsal osteotomy combined with distal soft tissue realignment is accepted as standard treatment of moderate to severe hallux valgus with metatarsus primus varus, none of the described proximal metatarsal osteotomies address the hyper-obliquity of the first metatarsocuneiform joint. An opening-wedge osteotomy of the medial cuneiform can potentially correct the 1-2 intermetatarsal angle (IMA) in addition to normalizing the hyper-obliquity of the first tarsometatarsal (TMT) joint. The purpose of this study was to retrospectively review the early radiographic and clinical results of the use of a medial cuneiform opening-wedge osteotomy fixed with a low-profile wedge plate combined with distal soft tissue realignment for the treatment of hallux valgus. Methods: Fourteen feet (13 patients; 2 male and 11 female, average age 56 years, range 22-75) with hallux valgus underwent an opening-wedge osteotomy of the medial cuneiform fixed with a low-profile nonlocking wedge plate combined with distal soft tissue realignment. The mean preoperative hallux valgus angle (HVA) was 32 degrees and the IMA was 16 degrees. HVA, 1-2 IMA, proximal first metatarsal inclination (PFMI), and presence of osteoarthritis of the first TMT joint were assessed on preoperative and final postoperative radiographs. Final postoperative radiographs were also evaluated for radiographic union and hardware failure at an average of 7 months (range, 3-19 months) postoperatively. Results: A mean intraoperative correction of 19 degrees and 7 degrees was achieved for the HVA and IMA, respectively. The mean HVA was 22 degrees and the mean IMA was 11 degrees at the time of final follow-up. At final follow-up, a recurrence of the deformity was observed in 12/14 feet. There were 2 nonunions—one plate failure and one screw failure. No first TMT joint instability or arthritis was observed. All patients were ambulatory without assistive device in either fashionable or comfortable shoe wear. Conclusion: Medial cuneiform opening-wedge osteotomy resulted in unreliable correction of HVA and IMA at short-term follow-up with a high rate of early recurrence of hallux valgus deformity and a complication rate similar to that of the Lapidus procedure. This procedure cannot be recommended for addressing hallux valgus in the setting of increased obliquity of the first TMT joint. Level of Evidence: Level IV, case series.

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