First cuneiform osteotomy alters hindfoot architecture

Three-dimensional concepts underlie various congenital foot deformities in the midfoot. We wondered whether the first cuneiform osteotomy, usually indicated for forefoot correction, had an effect on the hindfoot. We retrospectively studied 18 patients (31 feet) with metatarsus adductus and varus who had a biplane first cuneiform osteotomy between 1994 and 2001. No patients had associated malformations or neuromuscular disease. All had persistent pain and functional complaints for at least 2 years before surgery, and all had a minimum followup of 2 years. Group A (13 feet) with forefoot adduction without hindfoot valgus had an isolated first cuneiform osteotomy. Group B (18 feet) with slight forefoot adduction, hindfoot valgus, and supination after hindfoot valgus correction had first cuneiform osteotomy and a subtalar arthrodesis. At 5 years mean followup we evaluated multiple measurements on preoperative and followup weightbearing radiographs. Complementary demographic information and clinical patient information were collected. First cuneiform osteotomy was associated with architectural changes in hindfoot bone angles. This finding suggests new surgical approaches. Level of Evidence: Therapeutic Study. Level IV (Case series). See the Guidelines for Authors for a complete description of levels of evidence.