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Postoperative Medial Cuneiform Position Correlation With Patient-Reported Outcomes Following Cotton Osteotomy for Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity.
Foot Ankle Int. 2019 May; 40(5):491-498.FA

Abstract

BACKGROUND

Residual supination of the midfoot during reconstruction of the stage II adult-acquired flatfoot deformity (AAFD) is often addressed with a medial cuneiform (Cotton) osteotomy after adequate correction of the hindfoot valgus deformity. The purpose of this study was to determine if there was a correlation between postoperative alignment of the medial cuneiform and patient-reported outcomes.

METHODS

Sixty-three feet in 61 patients with stage II AAFD who underwent a Cotton osteotomy as part of a flatfoot reconstruction were included in the study. Radiographic angles were measured on weightbearing lateral radiographs at a minimum of 40 weeks postoperatively. Pearson's correlation analysis was used to determine if there was an association between postoperative radiographic angles and Foot and Ankle Outcome Score (FAOS) at a minimum of 24 months postoperatively. Patients were also divided into mild plantarflexion (cuneiform articular angle [CAA] ≥-2 degrees) and moderate plantarflexion (CAA <-2 degrees) groups to evaluate for differences in clinical outcomes.

RESULTS

Postoperative CAA was significantly positively correlated with the postoperative FAOS symptoms (r = .27, P = .03), daily activities (r = .29, P = .02), sports activities (r = .26, P = .048), and quality of life (r = .28, P = .02) subscales. Patients in the mild plantarflexion group had statistically and clinically better outcomes compared with the moderate plantarflexion group in the FAOS symptoms (P = .04), daily activities (P = .04), and sports activities (P = .01) subscales.

CONCLUSIONS

Our study suggests that the surgeon should avoid excessive plantarflexion of the medial cuneiform and use the Cotton osteotomy judiciously as part of a flatfoot reconstruction for stage II AAFD.

LEVEL OF EVIDENCE

Level III, comparative series.

Authors+Show Affiliations

1 Hospital for Special Surgery, New York, NY, USA.1 Hospital for Special Surgery, New York, NY, USA.2 Georgetown University School of Medicine, Washington, DC, USA.1 Hospital for Special Surgery, New York, NY, USA.1 Hospital for Special Surgery, New York, NY, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30654660

Citation

Conti, Matthew S., et al. "Postoperative Medial Cuneiform Position Correlation With Patient-Reported Outcomes Following Cotton Osteotomy for Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity." Foot & Ankle International, vol. 40, no. 5, 2019, pp. 491-498.
Conti MS, Garfinkel JH, Kunas GC, et al. Postoperative Medial Cuneiform Position Correlation With Patient-Reported Outcomes Following Cotton Osteotomy for Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. Foot Ankle Int. 2019;40(5):491-498.
Conti, M. S., Garfinkel, J. H., Kunas, G. C., Deland, J. T., & Ellis, S. J. (2019). Postoperative Medial Cuneiform Position Correlation With Patient-Reported Outcomes Following Cotton Osteotomy for Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. Foot & Ankle International, 40(5), 491-498. https://doi.org/10.1177/1071100718822839
Conti MS, et al. Postoperative Medial Cuneiform Position Correlation With Patient-Reported Outcomes Following Cotton Osteotomy for Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. Foot Ankle Int. 2019;40(5):491-498. PubMed PMID: 30654660.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postoperative Medial Cuneiform Position Correlation With Patient-Reported Outcomes Following Cotton Osteotomy for Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity. AU - Conti,Matthew S, AU - Garfinkel,Jonathan H, AU - Kunas,Grace C, AU - Deland,Jonathan T, AU - Ellis,Scott J, Y1 - 2019/01/18/ PY - 2019/1/19/pubmed PY - 2020/1/31/medline PY - 2019/1/19/entrez KW - adult-acquired flatfoot deformity KW - medial cuneiform KW - outcome studies KW - reconstruction SP - 491 EP - 498 JF - Foot & ankle international JO - Foot Ankle Int VL - 40 IS - 5 N2 - BACKGROUND: Residual supination of the midfoot during reconstruction of the stage II adult-acquired flatfoot deformity (AAFD) is often addressed with a medial cuneiform (Cotton) osteotomy after adequate correction of the hindfoot valgus deformity. The purpose of this study was to determine if there was a correlation between postoperative alignment of the medial cuneiform and patient-reported outcomes. METHODS: Sixty-three feet in 61 patients with stage II AAFD who underwent a Cotton osteotomy as part of a flatfoot reconstruction were included in the study. Radiographic angles were measured on weightbearing lateral radiographs at a minimum of 40 weeks postoperatively. Pearson's correlation analysis was used to determine if there was an association between postoperative radiographic angles and Foot and Ankle Outcome Score (FAOS) at a minimum of 24 months postoperatively. Patients were also divided into mild plantarflexion (cuneiform articular angle [CAA] ≥-2 degrees) and moderate plantarflexion (CAA <-2 degrees) groups to evaluate for differences in clinical outcomes. RESULTS: Postoperative CAA was significantly positively correlated with the postoperative FAOS symptoms (r = .27, P = .03), daily activities (r = .29, P = .02), sports activities (r = .26, P = .048), and quality of life (r = .28, P = .02) subscales. Patients in the mild plantarflexion group had statistically and clinically better outcomes compared with the moderate plantarflexion group in the FAOS symptoms (P = .04), daily activities (P = .04), and sports activities (P = .01) subscales. CONCLUSIONS: Our study suggests that the surgeon should avoid excessive plantarflexion of the medial cuneiform and use the Cotton osteotomy judiciously as part of a flatfoot reconstruction for stage II AAFD. LEVEL OF EVIDENCE: Level III, comparative series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/30654660/Postoperative_Medial_Cuneiform_Position_Correlation_With_Patient_Reported_Outcomes_Following_Cotton_Osteotomy_for_Reconstruction_of_the_Stage_II_Adult_Acquired_Flatfoot_Deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100718822839?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -