Cotton Osteotomy

Abstract

The Cotton osteotomy is a medial cuneiform dorsal opening wedge osteotomy which is utilized in the treatment of the collapsing pes planovalgus foot type, metatarsus primus elevatus deformity, the overcorrected clubfoot, and forefoot varus deformity. It is most commonly performed as an adjunct to hindfoot reconstruction when the medial column requires additional plantarflexion in order to obtain a plantigrade foot. The procedure is relatively simple to perform with limited complications. Anatomic landmarks are carefully identified grossly and fluoroscopically to ensure proper placement of the sagittal saw prior to making the osteotomy. Graft material consists of either autograft, allograft, or metallic, wedge-shaped implants that are coupled with internal fixation to provide additional stability to the graft and osteotomy site. Whether used as an isolated procedure or in conjunction with other hindfoot procedures, the Cotton osteotomy is a powerful corrective procedure to address sagittal plane deformity of the midfoot.