Biplane cuneiform osteotomy for juvenile metatarsus primus varus.

An operation combining the procedures of Cotton and Fowler on the medial cuneiform has been used for the correction of juvenile metatarsus primus varus and is presented in this manuscript. The procedure consists of a biplanar opening wedge osteotomy of the medial cuneiform with insertion of a bone graft and internal fixation. This surgical approach evolves from the procedures of Cotton (a sagittal plane correction of the depressed distal medial column in pes planus), and Fowler (a transverse plane correction of the medial column for metatarsus adductus). The operation has been utilized at St. Anne's Hospitals and provides excellent reduction of the intermetatarsal angle, with realignment of an oblique metatarsal-cuneiform joint. The operation is done with the Hohmann osteotomy/bunionectomy for realignment of the metatarsophalageal joint to correct hallux valgus that exists with juvenile metatarsus primus varus.