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Residual Forefoot Supination Following Correction of Adult-Acquired Flatfoot Deformity
Adult-acquired flatfoot deformity is marked by a progressive change in the shape of the foot with increasing pes planovalgus over time, most commonly as the result of insufficiency of the posterior tibial tendon. Medial hindfoot pain and swelling with variable degrees of hindfoot valgus, forefoot abduction, and forefoot varus are reported. Typically, increasing pain and dysfunction are noted with weight-bearing activities. The procedures that have been used include FDL transfer and spring ligament repair for reconstruction of the medial soft tissues, along with bony procedures such as medial displacement calcaneal osteotomy to correct hindfoot valgus and lateral column lengthening to correct forefoot abduction. None of these procedures addresses residual forefoot supination (forefoot varus), however. This chapter focuses on the use of the Cotton osteotomy and first TMT joint arthrodesis to correct residual forefoot varus following surgical treatment of adult-acquired flatfoot.