Tags

Type your tag names separated by a space and hit enter

Contribution of Medial Cuneiform Osteotomy to Correction of Longitudinal Arch Collapse in Stage IIb Adult-Acquired Flatfoot Deformity.
Foot Ankle Int. 2018 08; 39(8):885-893.FA

Abstract

Background Residual forefoot supination after correcting the hindfoot in stage IIb adult-acquired flatfoot deformity can be addressed with a dorsal opening wedge medial cuneiform (Cotton) osteotomy. The amount of correction is generally judged clinically, and there currently are no preoperative guides that can predict the size of graft needed. The aim of this study was to evaluate the correlation between patient and operative factors and the correction achieved with the Cotton osteotomy.

METHODS

Seventy-nine feet in 74 patients undergoing Cotton osteotomy as part of flatfoot reconstruction were reviewed retrospectively. Preoperative and minimum 40-week postoperative lateral foot weightbearing radiographs were compared to assess correction of longitudinal arch collapse as measured by 13 radiographic parameters, with particular emphasis on the cuneiform articular angle (CAA). Additional demographic and intraoperative variables analyzed for association with radiographic change included age, gender, body mass index, amounts and graft types of Cotton osteotomy and lateral column lengthening, and amount of medializing calcaneal osteotomy. A multivariate linear regression model was developed for each variable found to be significant in univariate analysis.

RESULTS

The Cotton osteotomy graft size was significantly associated with changes in the CAA (P < .001), calcaneal pitch (P = .03), lateral talonavicular Cobb angle (P = .03), and lateral naviculomedial cuneiform Cobb angle (P = .03). The Cotton graft size was the only factor found to significantly predict a change in the CAA in the final linear regression model (P < .001, R2 = 0.27), with each millimeter of Cotton corresponding to a 2.1-degree decrease of the CAA.

CONCLUSION

Correction of longitudinal arch collapse, as measured by the CAA, was primarily influenced by the size of the graft used for the Cotton osteotomy in a linear fashion. The preoperative CAA may help surgeons titrate the proper amount of graft placed intraoperatively.

LEVEL OF EVIDENCE

Level IV, Retrospective Case Series.

Authors+Show Affiliations

1 Georgetown University School of Medicine, Washington, DC, USA.2 Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA.3 Foot and Ankle Service, Department of Orthopaedic Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA.4 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.4 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29619845

Citation

Kunas, Grace C., et al. "Contribution of Medial Cuneiform Osteotomy to Correction of Longitudinal Arch Collapse in Stage IIb Adult-Acquired Flatfoot Deformity." Foot & Ankle International, vol. 39, no. 8, 2018, pp. 885-893.
Kunas GC, Do HT, Aiyer A, et al. Contribution of Medial Cuneiform Osteotomy to Correction of Longitudinal Arch Collapse in Stage IIb Adult-Acquired Flatfoot Deformity. Foot Ankle Int. 2018;39(8):885-893.
Kunas, G. C., Do, H. T., Aiyer, A., Deland, J. T., & Ellis, S. J. (2018). Contribution of Medial Cuneiform Osteotomy to Correction of Longitudinal Arch Collapse in Stage IIb Adult-Acquired Flatfoot Deformity. Foot & Ankle International, 39(8), 885-893. https://doi.org/10.1177/1071100718768020
Kunas GC, et al. Contribution of Medial Cuneiform Osteotomy to Correction of Longitudinal Arch Collapse in Stage IIb Adult-Acquired Flatfoot Deformity. Foot Ankle Int. 2018;39(8):885-893. PubMed PMID: 29619845.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contribution of Medial Cuneiform Osteotomy to Correction of Longitudinal Arch Collapse in Stage IIb Adult-Acquired Flatfoot Deformity. AU - Kunas,Grace C, AU - Do,Huong T, AU - Aiyer,Amiethab, AU - Deland,Jonathan T, AU - Ellis,Scott J, Y1 - 2018/04/05/ PY - 2018/4/6/pubmed PY - 2019/5/28/medline PY - 2018/4/6/entrez KW - AAFD KW - Cotton osteotomy KW - adult-acquired flatfoot deformity KW - forefoot supination KW - longitudinal arch collapse KW - medial cuneiform osteotomy SP - 885 EP - 893 JF - Foot & ankle international JO - Foot Ankle Int VL - 39 IS - 8 N2 - : Background Residual forefoot supination after correcting the hindfoot in stage IIb adult-acquired flatfoot deformity can be addressed with a dorsal opening wedge medial cuneiform (Cotton) osteotomy. The amount of correction is generally judged clinically, and there currently are no preoperative guides that can predict the size of graft needed. The aim of this study was to evaluate the correlation between patient and operative factors and the correction achieved with the Cotton osteotomy. METHODS: Seventy-nine feet in 74 patients undergoing Cotton osteotomy as part of flatfoot reconstruction were reviewed retrospectively. Preoperative and minimum 40-week postoperative lateral foot weightbearing radiographs were compared to assess correction of longitudinal arch collapse as measured by 13 radiographic parameters, with particular emphasis on the cuneiform articular angle (CAA). Additional demographic and intraoperative variables analyzed for association with radiographic change included age, gender, body mass index, amounts and graft types of Cotton osteotomy and lateral column lengthening, and amount of medializing calcaneal osteotomy. A multivariate linear regression model was developed for each variable found to be significant in univariate analysis. RESULTS: The Cotton osteotomy graft size was significantly associated with changes in the CAA (P < .001), calcaneal pitch (P = .03), lateral talonavicular Cobb angle (P = .03), and lateral naviculomedial cuneiform Cobb angle (P = .03). The Cotton graft size was the only factor found to significantly predict a change in the CAA in the final linear regression model (P < .001, R2 = 0.27), with each millimeter of Cotton corresponding to a 2.1-degree decrease of the CAA. CONCLUSION: Correction of longitudinal arch collapse, as measured by the CAA, was primarily influenced by the size of the graft used for the Cotton osteotomy in a linear fashion. The preoperative CAA may help surgeons titrate the proper amount of graft placed intraoperatively. LEVEL OF EVIDENCE: Level IV, Retrospective Case Series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/29619845/Contribution_of_Medial_Cuneiform_Osteotomy_to_Correction_of_Longitudinal_Arch_Collapse_in_Stage_IIb_Adult_Acquired_Flatfoot_Deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100718768020?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -