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The Cole Midfoot Osteotomy: Clinical and Radiographic Retrospective Review of Five Patients (Six Feet) with Different Etiologies

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  • 1 Acibadem Mehmet Ali Aydinlar Universitesi, Ortopedi ve Travmatoloji Ana Bilim Dali, Istanbul, Turkey.
  • | 2 Ozel Kurtkoy Ersoy Hastanesi, Istanbul, Turkey.
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Cole osteotomy is performed in patients having a cavus deformity with the apex of the deformity in the midfoot. Correction of the deformity at this midfoot level improves foot and ankle stability by creating a plantigrade foot. We retrospectively reviewed the clinical and radiographic results of six feet (five patients) that underwent Cole midfoot osteotomy (2011–2015).


The patients had different etiologies (spastic cerebral palsy, burn sequelae, spina bifida, and Charcot-Marie-Tooth disease). Dorsal and slightly laterally based transverse wedge osteotomy through the navicular bone medially and the cuboid bone laterally was performed. Patients were under routine clinical follow-up. We evaluated clinical and radiographic results.


Mean clinical follow-up was 15.7 months (range, 6–36 months). The mean preoperative and postoperative talo–first metatarsal angles on lateral radiographs were 29.9° and 8.7°, respectively (P < .05) and on anteroposterior radiographs were 30.3° and 8.6° (P < .05). The mean preoperative talocalcaneal angle on anteroposterior radiographs increased from 19.2° to 29.8° postoperatively (P < .05). The mean postoperative calcaneal pitch angle change was 10.8° on the lateral radiograph (P < .05). At final follow-up, all five patients were independently active, had plantigrade feet, and were able to wear conventional shoes. The mean American Orthopaedic Foot and Ankle Society questionnaire score was 38.8 preoperatively and 79.5 postoperatively (P < .05). Only one patient did not have full bony union. Achilles tightness was seen in one patient.


Cole midfoot osteotomy is a laboring procedure to correct adult pes cavus deformity with the apex in midfoot, although having some complication risks.

Corresponding author: Selim Ergun, MD, Kozyatagi Acibadem Hastanesi, 34734, Kozyatagi-Kadikoy, Istanbul, Turkey. (E-mail: drselimergun@gmail.com)