Preparation
Before the procedure, your orthopedic foot and ankle specialist will evaluate your symptoms, medical history, and imaging studies such as X-rays or MRI scans. You may be a candidate for a Cotton osteotomy if:
- You have a flexible flatfoot deformity
- Non-surgical treatments like orthotics or physical therapy haven’t helped
- You’re experiencing ongoing arch pain, fatigue, or difficulty walking
Your surgeon will discuss the full surgical plan, which may include combining the Cotton osteotomy with other foot procedures to achieve the best outcome.
Modifying the Bone
During surgery:
- A small incision is made over the top of the foot.
- The medial cuneiform bone is carefully cut, creating space for a bone graft.
- A wedge-shaped bone (either synthetic or taken from a donor) is inserted into the gap.
- The graft shifts the front part of the foot downward, lifting the arch and improving alignment.
The graft is secured with small hardware, such as screws or plates, to ensure it heals properly in the new position.
End of Procedure and Aftercare
After surgery, your foot will be placed in a splint or boot to protect the area while it heals. You’ll likely need to avoid putting weight on your foot for several weeks.
Most patients follow a structured recovery plan that includes:
- Weeks 0–6: Non-weight bearing in a cast or boot
- Weeks 6–12: Gradual return to weight-bearing as healing progresses
- Physical therapy to restore strength, flexibility, and balance
- Return to full activity often takes 3–6 months, depending on individual progress
Your orthopedic team will guide you every step of the way to ensure your foot heals well and regains strength.
FAQs
You may need a Cotton osteotomy if you have flexible flatfoot that causes pain, fatigue, or difficulty with walking. The procedure helps raise the arch and improve foot mechanics when conservative treatments haven’t worked.
Flat feet or “fallen arches” can be caused by genetics, injury, arthritis, or wear-and-tear over time. In some cases, the ligaments and tendons that support the arch weaken, leading to collapse and poor alignment.
Most patients recover over the course of 3–6 months. You’ll begin by keeping weight off your foot, then slowly progress through physical therapy and return to full activity.
Walking typically resumes around 6–8 weeks after surgery, once the bone graft has begun to heal and your surgeon confirms it’s safe to bear weight.
It’s considered a routine, low-risk procedure when performed by a foot and ankle specialist. While it’s a surgical intervention, it’s often very effective in restoring foot function and reducing pain from flatfoot deformity.
As with any surgery, risks include infection, delayed bone healing, hardware irritation, or continued foot discomfort. These complications are relatively rare and can usually be managed successfully with follow-up care.
