title: Opening wedge osteotomy of the medial cuneiform before age 4 years in the treatment of forefoot adduction.
abstract: Thirty-seven feet in 25 children (12 girls, 13 boys) treated surgically with medial cuneiform opening wedge osteotomy to correct forefoot adduction were assessed. Thirteen patients had unilateral deformity. Primary diagnoses were congenital clubfoot (33 feet), congenital forefoot adduction (3 feet), and skewfoot (1 foot). All children underwent operation before age 4 years. The age at operation ranged from 21 to 47 months (mean 35). In 18 feet, allografts were used. In 5 feet, autograft was used. In 14 feet, ceramic material was inserted as opening wedge. Follow-up ranged from 3 to 8 years (mean 4). In four feet, the ossification center of the medial cuneiform was invisible. The correction of the deformity was assessed clinically and radiographically. The first ray angle and talo-first metatarsal angle were evaluated on anteroposterior radiographs, the latter was evaluated on lateral radiographs, also. In 26 feet, normal position of the forefoot was achieved. In five feet, overgrowth of the medial cuneiform in comparison with the normal side was observed. Forefoot adduction persisted in six feet. The ossification center was often divided into two parts by bone graft, and subsequent independent growth of both parts was observed. This technique is safe and useful for correction of forefoot adduction in young children. It can be performed even in cartilaginous bone. The osteotomy causes overgrowth of the medial cuneiform and the medial ray.
authors.affiliation: Karol Marcinkowski University of Medical Sciences, Poznań, Poland. ortop@webmedia.pl
authors.forename: Marek
authors.initials: M
authors.lastname: Napiontek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kotwicki
authors.forename: Marek
authors.initials: M
authors.lastname: Tomaszewski
mesh_terms: D002370:Casts, Surgical; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005532:Foot Deformities, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D005545:Forefoot, Human / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods* / Q000534:rehabilitation; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D018570:Risk Assessment; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome