Cotton Osteotomy (Medial Cuneiform Opening Wedge Osteotomy)


This surgical procedure helps to create an arch in the foot. It is commonly performed to help correct the condition of pes planus (commonly called flat foot or fallen arch). A Cotton osteotomy can change the shape of your foot, giving it a more normal appearance.


In preparation for this procedure, you are anesthetized. The surgeon creates an incision in the skin to access to the medial cuneiform. This is one of the bones of your midfoot.

Modifying the Bone

To reshape the foot, the surgeon carefully divides the medial cuneiform. A wedge is inserted between the two sections of bone. The wedge may be made from bone graft or metallic graft and held in place with a staple, plate or screws. Or, the surgeon may use a metal plate that is designed to act as its own wedge. This type of wedge is anchored to the bone with screws, and the space between the bones is filled with a malleable bone graft. All wedges are designed to lengthen the top of the medial cuneiform, creating an arch in your foot.

End of Procedure and Aftercare

When the procedure is complete, the incision is closed and the foot is bandaged. You will wear a cast for several weeks, and then you may transition to a walking boot. You may benefit from physical therapy as your foot heals.