Hospital for Special Surgery, Foot and Ankle Service, East River Professional Building, New York, NY, USA.
Foot Ankle Int. 2013 Sep;34(9):1221-6. doi: 10.1177/1071100713487726. Epub 2013 Apr 26.
Residual forefoot supination is commonly encountered during a flatfoot reconstruction, and a new technique for its treatment is described. Contrary to the standard Cotton osteotomy, a plantar closing wedge osteotomy of the medial cuneiform (PCWOMC) was performed, which has a number of advantages.
We followed 10 feet in 9 patients who had a PCWOMC performed as the last step of a standard flatfoot reconstruction for the correction of residual forefoot supination. These patients were evaluated pre- and postoperatively by standardized radiographic parameters, Short Form-12 (SF-12), and Foot and Ankle Outcome Score (FAOS).
Patients were followed for an average of 25.8 months with final radiographic analysis performed at an average of 9.9 months. A significant difference (P < .001) between pre- and postoperative parameters was demonstrated for both lateral talus-first metatarsal angle and medial-cuneiform-to-ground distance. Likewise, there was a statistically significant improvement in the SF-12 score and 4 out of 5 components of the FAOS. One patient developed internal hardware-related symptoms, which were relieved following implant removal. All osteotomies healed uneventfully.
A PCWOMC can be considered an alternative to the Cotton osteotomy for the treatment of forefoot supination deformity in adult flatfoot reconstruction. The main advantage of this technique over the Cotton osteotomy was simplicity, as an additional dorsal incision and bone graft were not required.
Level IV, retrospective case series.
平足重建过程中常出现前足残留旋后，现介绍一种治疗该畸形的新技术。与标准的 Cotton 截骨术不同，我们采用了内侧楔骨跖骨闭合楔形截骨术（PCWOMC），该术式具有许多优点。
我们对 9 例 10 足患者进行了回顾性研究，这些患者均在标准平足重建的最后一步接受了 PCWOMC 治疗，以矫正前足旋后。通过标准化的影像学参数、SF-12 量表和 FAOS 对这些患者进行术前和术后评估。
患者平均随访 25.8 个月，最终影像学分析平均在术后 9.9 个月进行。术后 lateral talus-first metatarsal angle 和 medial-cuneiform-to-ground distance 等参数与术前相比差异有统计学意义（P <.001）。SF-12 量表和 FAOS 的 4 个分量表中的 5 个分量表评分均有统计学显著改善。1 例患者出现与内置物相关的症状，取出植入物后症状缓解。所有截骨均愈合良好，无并发症发生。
PCWOMC 可作为成人平足重建中治疗前足旋后畸形的 Cotton 截骨术的替代方法。与 Cotton 截骨术相比，该技术的主要优势在于操作简单，无需附加背侧切口和植骨。
IV 级，回顾性病例系列研究。
