Cotton Osteotomy: An Integral Midfoot Procedure for Forefoot Varus Correction

Forefoot varus is a component of the adult-acquired flatfoot deformity which had to be dealt with independently because isolated hindfoot procedures are insufficient to address this deformity. The dorsal opening wedge osteotomy of the medial cuneiform also known as the Cotton osteotomy is an effective and reliable procedure in the correction of forefoot varus with consistently reported good outcomes in terms of improved radiographic and functional outcomes with excellent bony union rate. Notably, it is also very versatile in that the degree of sagittal correction can be adjusted freely. The use of anatomic Cotton plates with titanium wedge integration makes the osteotomy even more robust with the prevention of early loss of correction and reduction of shear forces at the osteotomy site. Therefore, we describe our technique and experience using an anatomic Cotton plate with titanium wedge integration in Cotton osteotomy for forefoot varus. Level of Evidence: Level V.