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Introduction/Purpose: Interpositional arthroplasty (IPA) is a motion-preserving surgery in patients with advanced hallux rigidus. Literature displays several complications after the procedure including transfer metatarsalgia, cock-updeformity and infection. In a finite element model, shortening of the first metatarsal was associated with increased plantar pressure on lateral rays during gait. Additionally, there are reports of a positive correlation between first metatarsal shortening after hallux valgus surgery and transfer metatarsalgia of the second, third and fourth metatarsophalangeal joints. The goals of this study were to report the outcomes and complications of IPA using acellular dermal allograft (IPA-ADA) as well as study the changes in the length of the proximal phalanx of the hallux (P1) and the first metatarsal (M1) following the procedure. Methods: In this IRB-approved retrospective study, we assessed patients who underwent IPA-ADA in a single academic institute from 2019-2022. All patients' demographic data, surgical details, complications, and patient-reported outcomes (PROs) were extracted. On standing conventional anteroposterior (AP) foot views, we measured the lengths of the first metatarsal (M1), the second metatarsal (M2), the proximal phalanx of the big toe (P1), and the entire length of the hallux (HX). The ratio of M1/M2 and P1/HX were calculated. The first metatarsophalangeal joint space was measured at the medial and lateral aspects of the joint on the APview. All measurements were recorded pre-operatively, at six weeks follow-up, and at the final follow-up. Descriptive statistics were performed, and comparison between groups was performed using analysis of variance(ANOVA) or Kruskal Wallis test according to data normality. The Dunn-Bonferroni test was then performed for pairwise group comparisons. A p-value < 0.05 was considered significant. Results: Eleven patients were included, 9 being females (81.81%). Six were hallux rigidus Coughlin grade III (54.55%), and 5 were grade IV (45.45%). The average age was 59 years (SD±6.78), and the body mass index (BMI) was 26 (SD±4.79). At the final followup, there was significant shortening of the first ray in comparison to the pre-operative length evidenced by lower M1/M2 (82.63 SD±2.29 versus 75.42 SD±5.1; p=0.001) and P1/HX ratio53.38 ± 2.29 versus 48.98 SD ± 7.92; p=0.001). Although there was no significant difference between M1/M2 at 6 weeks and at the final follow-up (p=0.716), there was a significant negative correlation between follow-up length and M1/M2 (r= -0.76, p=0.003). Follow-up was (19.95 months; range 3-39). Complications and PROs are listed in Figure 1. Conclusion: Interposition arthroplasty using dermal allograft for HR is associated with progressive shortening of the first ray at the level of the first metatarsal as well as the proximal phalanx. Although the study did show shortening of the first ray, the small sample size didn't allow for a correlation between this shortening and complications such as transfer metatarsalgia and cock-up toe deformity. The potential shortening should be considered in the selection of patients, particularly in the setting of an already short first metatarsal or when simultaneous Akin/Moberg osteotomy is planned. [ABSTRACT FROM AUTHOR]

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The first-ray and the medial column play a crucial role in preserving the tripod of the foot. Changes to structural properties of the first-ray, along with collapse of the medial-longitudinal-arch, have been associated with hallux valgus (HV). Thus, restoring the first-ray plays an important role when correcting the mechanical function of the foot tripod in the setting of HV combined with medial-longitudinal-arch collapse. The LapiCotton technique combines the mechanical advantages of Cotton osteotomy and modified Lapidus procedures by maintaining the length of the first-ray and preserving the medial- longitudinal-arch by plantar inclination of the distal part of first-ray. The aim of this study was to evaluate the effectiveness of the LapiCotton procedure in correcting selected radiographic parameters in patients with combined VH with medial-longitudinal arch collapse. Methods: Preoperative and postoperative Weight Bearing CT (WBCT) scans were obtained from HV patients who underwent unilateral LapiCotton procedure. Postoperative scans were obtained roughly three months after the date of surgery. Semi- automatic measurements were applied to 22 WBCT images across a total of 11 patients enrolled into the study using the Disior® Bonelogic® Software. Measurements of the hallux valgus angle (HVA), meary sagittal measurement, and intermetatarsal angles were taken from preoperative and postoperative scans. These scans were then compared using intraclass correlation coefficients and paired t-tests to evaluate the efficacy of the Lapicotton technique in treating HV with P-valus < 0.05 being significant. Results: HVA was found to be significantly larger (p=.026) in the preoperational group (Mdn = 27.52) than the postoperational group (Mdn = 20). In addition, the Meary sagittal measurement was found to be significantly different between groups (p=.033), with a larger value seen in the preoperational group (Mdn = -14.28) compared to the post-operational group (Mdn = -11.15). It was also observed that the IMA was significantly larger (p=.003) in the preoperative group (Mdn = 15.68) compared to the postoperative group (Mdn = 11.26). The sesamoid rotation was found to be higher in the preoperative group (Mdn = -17.71) than the post operative group (Mdn = -24.98), however, these values were not significantly different from one another (p=.203). Conclusion: The LapiCotton procedure proved to be effective in correcting radiographic parameters in patients with HV combined with collapse of the medial longitudinal arch. Reliable correction of HV, along with correction of medial longitudinal arch collapse, was quantified based on semi-automated WBCT measurements of HVA, IMA and Meary angle. LapiCotton produced significantly different measurements for both HVA and IMA postoperatively, providing evidence that the LapiCotton procedure can successfully correct medial longitudinal arch collapse in patients with HV, as well as radiographically reduce the severity of the deformity. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Other Introduction/Purpose: Treatment of Progressive Collapsing Foot Deformity (PCFD) is controversial and surgical procedures utilized usually depend on the type and rigidity of deformities present (PCFD classes and stages), degree of soft tissue involvement, and surgeon's preference. Multiple surgical procedures are usually performed concomitantly to achieve adequate correction. Prospective data regarding the utilization of hindfoot joint-sparing reconstructive procedures in the treatment of flexible PCFD is scarce, and little is known about the influence of the different procedures utilized to treat PCFD in deformity correction and patient-reported outcomes (PROs). The objective of this prospective study was to evaluate the most used hindfoot joint-sparing procedures utilized by a single-surgeon to treat flexible PCFD, and the influence of the utilized procedures in deformity pattern corrections, and PROs. Methods: IRB-approved, prospective, and comparative cohort study. Adult PCFD patients with flexible deformity (stage 1), no history of surgical treatment, and that failed conservative treatment for >3-months were enrolled. Patients underwent surgical treatment by a single-surgeon. Patients were excluded if a hindfoot fusion procedure was needed intra-operatively to achieve correction. Types, numbers, and sizes of surgical procedures utilized were recorded. Weight-bearing CT (WBCT) measurements of overall 3D deformity, Classes A (hindfoot valgus), B (abduction), C (medial column instability), D (peritalar subluxation), and E (ankle valgus tilt) were assessed preoperatively, and at first 3-months WBCT. PROs were recorded preoperatively and at the most recent follow-up. Descriptive statistics were used to report the frequency of deformity and procedures utilized. Pre and postoperative measurements and PROs were compared with paired T-tests/Wilcoxon. Multivariate regression analysis was used to correlate procedures utilized with deformity correction and PROs. P-values of >0.05 were considered significant. Results: A total of 29 patients included (28 feet, 79%F, 21%M), mean age and BMI of respectively 47.6-years and 34kg/m2. Average number of procedures performed was five and mean follow-up was 19.1 months (range, 3 to 40). Frequency and sizes of medial displacement calcaneal osteotomy (MDCO), first ray plantarflexion procedure (Cotton/LapiCoton), and lateral column lengthening (LCL) procedures were, respectively: 100% (8.9mm displacement), 100% (66% Lapicotton/34% Cotton, 8.3mm wedge-opening) and 39% (6.8mm wedge-opening). Soft-tissue procedures performed: 83% Posterior tibial tendon (re-tensioning/FDL transfer/allograft reconstruction), 34% peroneal tendon (brevis-to-longus and brevis lengthening), 76% gastrocnemius-recession, 38% spring ligament (re-tensioning/reconstruction/augmentation) and 31% deltoid ligament (re- tensioning/reconstruction/augmentation). Significant improvement postoperatively was observed in all PCFD measurements performed and PROs (Figure). However, no direct correlation was found between procedures performed/measurement improvements and PROs. Conclusion: In this prospective comparative cohort study of flexible PCFD patients undergoing surgical treatment with hindfoot joint sparing surgical procedures, we observed significant postoperative improvement in all deformity patterns assessed (Classes A, B, C, and D) as well as PROs. MDCO and first ray plantarflexion procedures (Cotton or LapiCotton) were the most commonly utilized procedures and were performed in all cases. Even though deformity correction and PRO improvements were observed postoperatively, no direct correlation was observed between PROs and specific surgical procedures performed or deformity pattern corrections (PCFD classes). [ABSTRACT FROM AUTHOR]

Category: Other; Hindfoot Introduction/Purpose: Clubfoot deformity (CFD) is one of the most common congenital deformities of the foot and ankle and is characterized by different severities of foot equinus, cavus, varus, and adduction. The gold-standard treatment is the Ponseti technique, characterized by serial casting and an Achilles tenotomy. Few studies have assessed long-term outcomes of this treatment, and none have utilized three-dimensional (3D) weightbearing analysis of residual CFD. The goals of this study were to elucidate residual 3D foot deformities in CFD patients treated with the Ponseti technique and to compare them with healthy controls. We also aimed to assess how these deformities influenced patient-reported outcomes (PROs). We hypothesized that significant residual deformities would be observed in CFD patients and that these deformities would negatively impact PROs. Methods: IRB-approved, prospective, comparative, and controlled study. We recruited 37 CFD patients (57 feet) treated with the Ponseti technique that had no additional foot and ankle surgical procedures. We also included 14 healthy control volunteers (28 feet) with no history of foot/ankle injuries/deformities. All patients underwent WBCT imaging (CurveBeam, HiRise). Tarsal bones were semi-automatically segmented (Bonelogic®, Disior), and several automatic measurements assessing cavus, varus, adductus, and overall 3D deformity (Foot and Ankle Offset – FAO) were performed. Measurements were then correlated with PROs, which included Visual Analogue Scale for pain, PROMIS general health, PROMIS physical function and pain interference, pain catastrophizing scale (PCS), and European Foot and Ankle Society (EFAS) score. Paired T-tests or Paired Wilcoxon were utilized to compare measurements between CFD patients and controls, depending on normality distribution. A multivariate regression analysis assessed the relationship between residual deformities and PROs in CFD patients. P-values < 0.05 were considered significant. Results: No significant overall residual 3D-deformity was found, with similar FAO measurements in CFD and controls (respectively, 2.63% and 3.2%/P=0.58). Slight cavus overcorrection was observed in CFD, with sagittal plane talus-first metatarsal angle of -0.12° versus -5.2o (p=0.04) and calcaneal inclination angle of 13.01° versus 21.5°, respectively. Varus under-correction was identified in CFD patients, with decreased sagittal and axial talocalcaneal angles (44.3o vs. 57.5o/p < 0.0001 and 17.7o vs. 25.78o/p=0.0012, respectively). Similarly, adductus under-correction was observed in CFD, with talonavicular coverage angle 18.63o vs. 29.19o (p < 0.0001). In the multivariate regression analysis, cavus overcorrection (sagittal talus-first metatarsal angle) was the only deformity influencing VAS (R2=0.19/P=0.02) and EFAS-Scores (R2=0.27/p=0.002). Residual varus deformity (sagittal plane talocalcaneal angle) was the only deformity influencing PROMIS Pain Interference (R2=0.14/p=0.038) and Physical Function (R2=0.32/p=0.0007). Conclusion: This study highlights the efficacy of the Ponseti technique in treating the overall 3D foot and ankle deformity in CFD patients, realigning the ankle joint and the weightbearing foot tripod. However, residual CFD components were identified, including overcorrection of the cavus and under-correction of the adductus and varus deformities. Overcorrection of the cavus negatively influenced VAS pain and EFAS scores, and under-correction of the varus negatively influenced PROMIS scores. The results of this study could potentially guide CFD treatment with the Ponseti technique, with focus on improved correction of the varus and avoidance of overcorrection of the cavus deformities. [ABSTRACT FROM AUTHOR]

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Progressive Collapsing Foot Deformity (PCFD) can present with independent deformities, characterized by five classes: hindfoot valgus (Class A), midfoot abduction (Class B), forefoot varus (Class C), Peritalar Subluxation (PTS) (Class D) and ankle valgus (Class E). Conservative treatment includes the use of corrective insoles and orthotics. Arch support inflatable Ankle-Foot orthoses (IAFO) can help control symptoms in PCFD patients. However, the ability of IAFOs to correct deformities in PCFD is unknown. The aim of this prospective comparative and controlled study was to assess the ability of arch support IAFOs to correct 3D overall PCFD alignment as well as the five different PCFD classes independently. We hypothesized that IAFOs would correct PCFD 3D overall alignment as well as the five independent classes of deformity. Methods: After IRB approval, we enrolled 24 symptomatic PCFD and 24 controls matched on age, sex, and BMI. Flexible PCFD patients and controls were scanned using Weight-Bearing CT (WBCT) with and without an arch support IAFO. The Foot and Ankle Offset (FAO) was used to assess the 3D foot overall alignment. We measured the Hindfoot moment arm (HMA, Class A), the Talonavicular coverage angle (TNCA, Class B), the Meary's angle and medial cuneiform-to-floor distance (C1-floor) for the Class C and the middle facet uncoverage (MFunco, Class D). No Class E patients were included. Measurements were performed by two fellowship-trained surgeons. A power-analysis hypothesizing that IAFOs would be two times less efficient than the PCFD surgery in correcting the FAO, the requisite number of subjects was 24 per group. Data normality was assessed by Shapiro-Wilk test. Comparisons used normality based paired T-tests or paired-Wilcoxon tests. P-values < 0.05 were considered significant. Results: PCFD measurements performed in controls were all significantly less pronounced than unbraced PCFD patients, confirming the presence of collapse (ps < 0.0001). Comparing PCFD without and with IAFO, the FAO did not show significant improvement (respectively 6.6+/-3.7% vs 5.5+/-4.2%, p=0.101). The HMA (8.8+/-5.8 vs 8.1+/-5.8, p=0.66), the TNCA (24.2+/-10.6 vs 21.9+/-9.7, p=0.44) and the MFunco (37+/-12% vs 31+/-18%, p=0.17) also did not portray significant improvements when applying the IAFOs. The Meary's angle (17.6+/-7.2 vs 10.8+/-7.3, p=0.002) and C1-floor (17.2+/-3.3mm vs 24.1+/-5.3mm, p< 0.001) were the only to improve significantly with use of IAFOs. When comparing braced PCFD and controls, the only measurement that improved to normal values, similar to controls, in braced PCFD was the C1-floor (24.1+/-5.3mm in PCFD with IAFO vs 25.7+/- 5.4mm in controls, p=0.31). Conclusion: In this prospective comparative and controlled study, we found that arch support IAFOs was not able to correct overall 3D deformity and most of the specific classes in PCFD. The orthosis did not improve hindfoot valgus (Class A), midfoot abduction (Class B) or peritalar subluxation (Class D) in PCFD. The only deformity pattern to improve with the use of IAFOs was the medial longitudinal arch height (Class C). These improvements were expected by the presence of the inflatable bladder of the IAFO on the plantar aspect of the foot, pushing the longitunal arch up but not correcting the entire PCFD. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Other Introduction/Purpose: The use of bio-integrative implants in orthopedic surgery is growing exponentially. Advantages, such as reduced implant-related artifact production, lower removal rates, and superior bone interaction, have been advocated. However, while many biomechanical and histological reports could sustain its structural and biological properties, only some clinical studies were produced that could support its use. Therefore, this trial intended to determine the bio-integrative screws' capacity to reach the same clinical and radiographical outcomes of current metallic screws in calcaneus osteotomies. Our main hypothesis was that metallic and bio-integrative screws would not present differences when comparing bone healing and complications. Methods: This was a single center, in parallel groups, randomized non-inferiority clinical trial (NCT05018130) that included patients undergoing a calcaneal sliding osteotomy from November 2021 to January 2023. Patients were randomized in a 1 to 1 ratio by software in the metallic or bio-integrative groups, and allocation occurred after anesthesia was carried out. Surgeries were performed by a single surgeon respecting the same technique, using two canulated 4mm screws, either titanium or fiber, according to the treatment group. The primary outcome was determined by bone using weight-bearing computed tomography (WBCT) in the 6th postoperative week. At least 50% of bone trabeculae crossing the osteotomy site needed to be observed to be considered positive. Secondary outcomes included minor and major complications and bone healing, assessed in the 2nd, 4th, 6th, 12th, 24th, and 48th weeks of follow-up. Two assessors performed readings. Between-group differences were measured with ANOVA and chi-square tests. Results: After twenty-nine patients were assessed initially, 22 subjects were found eligible and included in the study. Groups were similar demographically (ps>0.37), with ten patients allocated to the bio-integrative and 12 to the metallic group. The mean follow- up was 31.64 weeks (min 6; max 48) with no losses through the endpoints. Considering WBCT bone healing at six weeks, the bio (80%) and the metallic (75%) groups had similar rates (p=0.58). At 12 weeks, bone healing was slightly higher in the bio-integrative group (100% vs. 92%; p=0.004). No major complications were observed. Minor complications were similar between groups (10% in bio; 16% in metallic; p=0.56) and composed of superficial infections (one bio, one metallic) and delayed wound healing (one metallic), all resolved by six weeks. Conclusion: Bio-integrative screws presented similar results to metallic screws when used in calcaneus osteotomies, considering bone healing and complications. No differences were found in a medium to long-term follow-up, and no major complications were reported. This non-inferiority clinical trial could contribute to the body of literature supporting the use of bio-integrative screws in clinical practice. Larger and longer trials are necessary to determine the superiority of any implant and its impact on orthopedic surgery. [ABSTRACT FROM AUTHOR]

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Progressive collapsing foot deformity (PCFD), Hallux Valgus (HV), and Midfoot Arthritis (MA) are diseases that benefit from the Lapidus procedure due to its capability to provide a stable medial column while correcting the underlying deformity. However, the technique does not go without complications. First metatarsal shortening/dorsiflexion are not uncommon, which could be exacerbated by local anatomy/revision surgery settings. Restoring length and sagittal plane position (plantarflexion) of the first ray when treating these pathologies is paramount. Performing a primary distraction and plantarflexion fusion with an allograft wedge (LapiCotton) has been advocated in the literature, potentially allowing improved deformity correction, but with the risk of increased non-union rate. The objective of this study was to report medium-term follow-up results of the LapiCotton in patients with collapsed feet. Methods: This IRB-approved comparative prospective study assessed patients diagnosed with PCFD, HV, and MA undergoing a Lapidus bone-block fusion (LapiCotton) between August 2020 and November 2022. All patients were operated on by a single fellowship-trained foot and ankle surgeon after clinical evaluation and a weight-bearing computed tomography (WBCT). After adequate joint preparation and trials, a Lapidus pre-shaped wedge allograft was placed and fixed using available implants. Adjunctive procedures were carried out as needed. Patients were kept non-weight bearing for six weeks and followed clinically, performing a WBCT at three months and subsequent follow-up. Non-Union and complications were documented. Bone healing was determined by at least 50% of bone trabeculae crossing both graft interfaces at the WBCT. Forefoot arch angle (FFA), Meary's angle, talonavicular coverage angle (TNCA), middle facet subluxation (MFS), and foot and ankle offset (FAO) were also obtained. Two fellowship-trained readers performed all assessments. P-values >0.05 were considered significant. Results: Fifty-eight patients (60 feet) were included, mean age 53.87 (range:18-77)/BMI 31.70 (SD:7.96). Twenty-four PCFD, 19 HV, and 17 MA had an average 15.47 months (4-31) follow-up. Cuneiform-Post implants were used in 62%, plates/screws in 25%, and Lapidus nails in 13%. Median allograft size was 9mm (mode:8mm,5-19mm). Minor complications were observed in 3% (two superficial dehiscences) and major in 7% (three deep infections [5%], and one EHL contracture [2%]). Healing at the 3-month WBCT occurred in 94.8% and only in 66% at the most-recent WBCT (mean:11.08 months; 6-20). The clinical non-union rate demanding reoperation was eight clinical non-unions 13%. Mean FFA (pre:6.89,SD:6.63; postop:14.21,SD:5.48; p< 0.001), Meary (pre:15.17,SD:8.12; postop:6.31,SD:5.61; p< 0.001), TNCA (pre:26.75,SD:11.77; postop:11.59,SD:7.91; p< 0.001), MFS (pre:36.3,SD:26; postop:23.49,SD:17.35; p< 0.001), and FAO (pre:6.71,SD:5.81; postop:2.2,SD:4.33; p< 0.001) improved after the interventions. Conclusion: Although the Lapidus bone-block arthrodesis (LapiCotton) restored many of the markers associated with foot collapse and alignment, non-union rated was noted in 13% what is on the top range of non-union rates reported in the literature for Lapidus arthrodesis. The use of allograft wedges in the fusion site probably explains our findings. The fact that the sample was heterogeneous and composed of considerably severe deformities should also be considered. Also, important to highlight that WBCT findings of fusion site healing was initially 94% at 3-months and only 66% at most recent follow-up). Additional studies and longer-term follow up are needed. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Midfoot/Forefoot Introduction/ Purpose: Peritalar subluxation (PTS) is a crucial feature of Progressive Collapsing Foot Deformity (PCFD). Surrounding structures assume distinct behaviors, contributing to different disease deformities (classes). One of its most traditional aspects is the midfoot abduction (class B), usually noted by a lateral deviation of distal structures at the talonavicular joint. This finding commonly leads surgeons to perform a lateral column lengthening osteotomy for abduction correction, a complex surgery with potential complications. The first ray's ability to reestablish the tripod and restore the hindfoot by derotating structures under the talus was previously theorized. This study aimed to test the capability of the Lapidus and the Cotton procedures in conjunction with a calcaneus displacement osteotomy (MDCO) to improve midfoot abduction in the setting of a collapsed foot. Methods: In this IRB-approved, prospective cohort study, we analyzed patients undergoing medial column instability surgery and evaluated preoperatively with a weight-bearing CT (WBCT). We included individuals receiving a Lapidus bone block procedure or a Cotton for PCFD or Hallux Valgus (HV). Patients having a lateral column lengthening procedure of any type were excluded. Talonavicular coverage angle (TNCA) was measured as a marker of midfoot abduction. Medial arch collapse and forefoot varus were evaluated by the sagittal talus-first metatarsal angle (TFMA), and the forefoot arch angle (FFA) was measured. Associated procedures and the correction amount (displacement or wedge size) were recorded. Normality was estimated by the Shapiro- Wilk test and comparison among timelines by the one-way ANOVA. A multivariate regression analysis was executed to evaluate which of the measurements influenced abduction improvement. Statistical significance was considered for p-values of less than 0.05. Results: A total of 20 patients (age: 43.85 [19-72], BMI 30.98 [SD: 5.95]) were included, 11 PCFD (55%) and 9 HV (45%) with a mean follow-up of 7.5 months (3-12). Bone block Lapidus was performed in most subjects (90%), and the median wedge used was 9mm (5-12mm). MDCO occurred in 55% of patients. All measured variables had improvement with surgery (TNCA: 23.74 to 10.66, p< 0.0001; FFA: 6.27 to 12.67, p< 0.0001; TFMA: 11.73 to 4.22, p=0.0003). A correlation was found between TNCA improvement and FFA improvement (rs=0.46, p=0.0407), but not among TNCA improvement and TFMA improvement (rs=0.43, p=0.06). The size of the wedge did not strongly influence the TNCA correction (R2=0.016, p=0.0036), an improvement moderately explained by the MDCO amount (R2=0.186, p< 0.0001). Conclusion: This study demonstrated correction of midfoot abduction, translated by the TNCA, in the absence of lateral column lengthening procedures. When evaluating patients submitted to first ray procedures (bone block Lapidus and Cotton) in conjunction with MDCO, an enhancement on the talar head coverage was noted. Variables associated with arch height and forefoot varus (FFA and TFMA) were correlated with the TNCA improvement. Nevertheless, only the MDCO displacement amount and not the size of the used allograft wedge could explain changes in TNCA. The provided data might support surgeons when planning treatment in the PCFD scenario. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Medial column instability (MCI) in Progressive Collapsing Foot Deformity (PCFD) is not solely determined by forefoot varus (FV). First ray hypermobility, hallux valgus, midfoot arthritis, gapping at the tarsometatarsal joint and dorsal metatarsal migration are findings associated with MCI. Acknowledgement of this instability requires inclusion of a procedure to the medial column in order to correct the forefoot varus, stabilize the ray and bring the foot to a plantigrade tripod position. Cotton opening wedge medial cuneiform osteotomy and Lapidus tarsometatarsal arthrodesis are procedures of choice in these scenarios. We have combined these 2 procedures into one called Lapicotton. The purpose of this study was to present the short-term outcomes of this technique. We hypothesized that Lapicotton will improve both clinical and radiological outcomes. Methods: We performed an IRB-approved retrospective study comprising 3 PCFDs having benefited from a Lapicotton procedure. Clinical outcomes were assessed with the European Foot and Ankle Society Score (EFAS), the Foot Function Index Score (FFI) and the Pain Catastrophizing Scale (PCS). Radiographic outcomes were assessed using weight-bearing computed tomography (WBCT) assessments. Middle Cuneiform Floor distance, Forefoot Arch Angle, Middle Facet uncoverage percentage, Talonavicular Coverage angle and the Foot and Ankle Offset (FAO) were measured. All these data were both preoperatively and postoperatively collected. Comparison between preoperative and postoperative results were done as described below. The Kruskal-Wallis H-test for independent groups was used to compare median values of the EFAS. The Wilcoxon signed-rank test for paired samples was used to compare preoperative and postoperative variables of FFI and PCS. For the radiographic measurements, normality was assessed using Shapiro-Wilk test. Comparisons were made using Student tests for normal variables and Mann-Whitney for non-normals. Results: This small series included 2 female and 1 male, with a mean age of 56 and a mean BMI of 31.8 kg/m2. Mean follow up was 2.9+/-0.2 (range from 2.7 to 3.1) months. 2 out of 3 patients simultaneously benefited of a Medial Calcaneal Displacement Osteotomy (MDCO 10mm) and a Lateral Column Lengthening (LCL 8mm). The wedge sizes used for the Lapicotton were 8 mm in all cases. Regarding clinical outcomes, EFAS (p=0.79) and FFI (p=0.99) did not showed any significant improvement whereas PCS were significantly improved (Δ=-5.67[-9.2-2.2];p=0.03). Regarding radiological outcomes, fusion was present in all the cases at the maximal follow-up. Middle cuneiform floor distance and Forefoot Arch Angle were significantly increase (respectively Δ=6.9;CI95%=[6.4;7.4];p< 0.01 and Δ=7.5;CI95%=[4.3;10.8]p<0.05). Middle Facet uncoverage was significantly improved (Δ=- 28.8;CI95%=[-33.1;-24.5]p< 0.01). Statistical power of the serie did not allowed comparison regarding the Talonavicular Coverage Angle (Δ=-14;CI95%=[-24;-3.9]) and the FAO (Δ=-3.9;CI95%=[-10.7;2.9]). Conclusion: The Lapicotton procedure showed encouraging outcomes with fusion in all cases at 3 months postoperatively, improvement in pain, correction of forefoot varus and of the of the Peritalar subluxation represented by the Middle Facet Uncoverage. These results should be moderate because other procedures (MDCO and LCL) were performed in 2/3 of the patients, and the outcomes were issued from a small cohort with short-term follow-up. Longer follow-up and a larger cohort are needed to confirm these results. [ABSTRACT FROM AUTHOR]