PMC7366201_01
Preoperative photographs of the affected foot. (a) Lateral view of the weight-bearing foot showing rocker bottom deformity, elevated first metatarsal, interphalangeal hyperextension of the hallux, and ground contact at the interphalangeal joint of the hallux. (b) Sole of the foot showing callosity on the plantar surface of the interphalangeal joint of the hallux.
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Her right foot showed severe hindfoot valgus, rocker bottom deformity, and hyperextension of the hallux IP joint in the standing position (Figure 1).
Preoperative weight-bearing radiographs of the foot. (a) Anteroposterior view of the foot showing hallux valgus deformity and no clear space at the metatarsophalangeal joint. (b, c) Lateral view of the foot showing the destruction of the Chopart and subtalar joints, as well as misalignment of the hallux including elevation of the first metatarsal, plantar deviation of the proximal phalanx, and interphalangeal hyperextension. The two-way arrow indicates the distance between two dorsal cortices of the first and second metatarsals, indicating an elevated first metatarsal. The cross indicates the approximate center of the metatarsal head. Dotted lines show the naviculocuneiform and tarsometatarsal joints.
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The anteroposterior weight-bearing foot radiograph showed hallux valgus deformity and no clear space at the first MTP joint, but the configuration of the metatarsal head and proximal phalanx was preserved (Figure 2(a)). The findings from the lateral weight-bearing foot radiograph were as follows: (1) severe destruction of the mid- and hindfoot joints and collapse of the medial arch, (2) elevation of the first metatarsal, (3) plantar flexion and deviation of the hallux proximal phalanx, and (4) hyperextension deformity of the hallux distal phalanx (Figures 2(b) and 2(c)).
Postoperative weight-bearing radiographs of the foot. (a) Anteroposterior view of the foot showing improved hallux valgus deformity and congruent metatarsophalangeal joint. (b, c) Lateral view of the foot showing improvement of the elevated first metatarsal, plantar deviation of the proximal phalanx, and interphalangeal hyperextension. The two arrowheads indicate the distance between two dorsal cortices of the first and second metatarsals, indicating improvement of the elevated first metatarsal compared with Figure 2(c). The cross indicates the approximate center of the metatarsal head. Dotted lines drawn along the naviculocuneiform and tarsometatarsal joints demonstrate the improvement of plantar flexion by approximately 10  after the Cotton osteotomy.
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No progression of hindfoot destruction and flatfoot deformity has occurred (Figure 3).
Postoperative photographs of the foot 44 months after the primary surgery. (a) Lateral view of the weight-bearing foot showing the ground contact at the first metatarsal head. (b) Sole of the foot showing the disappearance of the callosity on the plantar surface of the first interphalangeal joint.
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The operated foot showed the disappearance of the callosity on the plantar hallux IP joint and ground contact at the first metatarsal head in the standing position (Figure 4).