The following patient information sheet is meant to help patients and family better understand a specific pediatric orthopaedic condition. It is not meant to be comprehensive, and only reflects one viewpoint. This page does not replace a medical evaluation by a pediatric orthopaedic surgeon, and your own surgeon may have a different approach to your condition.
What is an osteotomy?
Osteotomy means that the bone has been divided into two segments. In general, the bone is either shifted, or a wedge is removed or inserted to change the shape of the bone. It is then held in position with plates and screws, rods, wires and or casts until it heals.
When are osteotomies of the foot necessary?
Foot deformity is relatively common, and in many cases foot issues can be treated without surgery. However, if a child is having persistent pain and or functional issues despite other treatments, then surgery to reshape the foot is reasonable. I most commonly perform foot osteotomies for flatfoot, cavus foot, metatarsus adductus and hallux valgus.
What are the goals of surgery?
My goals are to improve the shape of the foot, improving pain and function. Whenever possible, I try to avoid any surgery involving the joints between the bones of the foot. This theoretically minimizes loss of motion and improves function of the foot, at the cost of not being able to fully restore the shape of the foot. This philosophy of preserving the joints at the expense of incomplete correction is shared by some but not all surgeons.
What can I expect with foot osteotomy surgery?
For flatfoot, cavus foot and metatarsus adductus I generally make incisions on both sides of the foot. For hallux valgus there is a main incision along the inside of the foot and a small incision on top of the foot. The osteotomies are held in position with pins. After surgery there is a splint from just below the knee to the end of the toes. If the heel bone is involved, then a drain is placed which is removed the following morning.
In general, your child stays overnight and is taught to use crutches the next day prior to discharge home. In one and half weeks the splint is wrapped over to create a full cast. At this point the pain should be substantially improved, although some still require narcotic pain medications.
At one month after surgery the pins are generally removed in clinic. Pin removal is momentarily uncomfortable, and almost all children can tolerate removal in clinic. A walking cast is then placed for an additional four weeks and the child is encouraged to gradually put weight on the foot as long as it is not painful.
At two months most children are walking, either in a boot or in normal shoes. If surgery of the other foot is under consideration, this is usually delayed until at least six months after the first surgery. At that time, the bones should be well healed, and the child should be experiencing the benefits of surgery.
What are the risks of surgery?
The most common issues after surgery is that the foot will still have some deformity. Stiffness of the foot is also possible, although this risk is theoretically lessened by the approach used in the osteotomies. See "What are the goals of surgery?" above for details on both of these.
Delayed healing of the bones can occur but is very uncommon. Rarely, it may be necessary to return to surgery to treat a bone that will not heal.
Nerve and blood vessel injury, joint stiffness, infection and wound issues are all quite uncommon with foot osteotomy surgery but all possible. General anesthesia always carries some risk although complications of anesthesia are also very uncommon.