Radiographic Outcomes and Complications of Medial Column Correction in Adult Acquired Flatfoot Deformity Using A Titanium Wedge

Abstract

Category: Hindfoot, Midfoot/Forefoot, Flatfoot Introduction/Purpose: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. There are multiple options to plantarflex the medial column of the foot, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 years (Range: 12-70). The average follow-up time for patients was 8.1 months (6-17 months). All patients underwent a six-month non-operative treatment course prior to operative intervention. The average time from the initial visit with the primary surgeon (JFD, ARK) to the day of surgical intervention was 211 days (29-1296 days). The choice to use a titanium wedge, versus an alternative method of correction of the medial column, was at the discretion of the primary surgeon (JFD, ARK). Results: A dorsal opening wedge medial cuneiform osteotomy was performed in all patients. All radiographic parameters showed statistically significant correction from preoperative to postoperative. All cases had multiple concomitant procedures performed to address the flatfoot deformity, so it is difficult to isolate the effect of the medial cuneiform osteotomy. 30/31 cases went on to successful union of the osteotomy within the study follow-up period. There were no instances of hardware pain requiring implant removal. There was 1 case of plantar gapping at the osteotomy site and implant loosening that required revision to a larger titanium wedge which healed uneventfully. No implants had supplemental fixation or additional bone graft placement at the osteotomy site. Conclusion: To our knowledge, this represents the first reported series on the use of structural titanium wedges with an opening wedge osteotomy of the medial cuneiform. There is limited data regarding the use of metal wedges for flatfoot correction. Nearly every patient in our series underwent concomitant procedures as part of the flatfoot reconstruction. This makes it difficult to isolate the effect of the deformity correction provided solely by the medial column correction. Our study suggests that metal wedges are both safe and effective for use in medial column correction, and future studies comparing titanium wedges to traditional techniques are needed.