COLEOSTEOTOMY

Expected Post Operative Course of Cavus Foot Correction with Cole Osteotomy

AIM:
To stabilise and improve the position and function of the foot under the leg. In addition, the aim is to substantially reduce pain in the foot associated with a high arched (Cavus foot).

HOW:
The Cole osteotomy involves removing a wedge of bone from the middle of the foot. Because the wedge is placed with its base at the bottom of the midfoot and the apex at the top of the midfoot it allows for the arch of the foot to be reduced. This occurs because after the wedge is removed the two ends of the midfoot are brought together.

WHERE:
This surgery is performed in a hospital or a day surgery centre and most patients are able to go home on the same day of surgery.

ANAETHESIA:
General anaesthesia in combination with local anaesthesia is most often used. Where appropriate a sedation type of anaesthetic (twilight anaesthetic) in combination with local anaesthetic block is used instead of general anaesthetic. Either way, the patient has a numb foot for 12 to 72 hours after surgery.

PAIN RELIEF:
The first form of pain relief used is the application of ice, elevation and a cast (to control swelling). In addition to this a local anaesthetic block used in surgery keeps the patient's foot numb for many hours after surgery. Medication will also be prescribed to control pain. It is important that the patient follows the directions for taking their medication in the postoperative period.

POST OPERATIVE COURSE:
For the first 3 days ice and elevation are used to control swelling. Walking with crutches should be kept to a minimum A recommended maximum amount of ambulation is 10 minutes of every hour that the patient is awake. This adds up to a total of 1 hour ambulation for each 24 hours. The patient's recovery will be aided if they ambulate the smallest amount possible in the first 3 days.

Depending on the exact nature of the surgery performed the cast is left in place for 6 to 8 weeks. When it is removed a cast of the foot is taken so a prescription orthotic device can be dispensed when the patient is ready to begin walking in a week or two after cast removal. Also, at the time of cast removal, X-rays are taken to check bone healing. The patient must not put any weight on the foot from the day of surgery until the podiatric surgeon* informs them otherwise.

WALKING:
This begins with a post operative shoe or boot supplied by the podiatric surgeon*. Crutches are used with the boot or shoe for the initial 3 to 7 days after weight bearing has commenced. After that time additional X-rays may be ordered to further assess bone healing. The postoperative shoe/boot is used for 2 to 4 weeks after commencement of walking.

A supportive sneaker (or lace up shoe) is then used with the new orthotic device for about 3 months.

In children, orthotic devices are used at least until they have stopped growing. It may be advisable to continue the use of orthotic devices in any patient after this type of surgery.

POST OPERATIVE REHABILITATION:
After this type of surgery the patient's foot will be more stable and will not flatten out when standing like it did before surgery. However there will be weakness in the muscles of the leg and foot. Simple exercises will be explained and demonstrated to the patient. If the patient is attentive to these exercises they will usually regain full power to these muscles within 3 to 6 months. Sometimes physical therapy will be needed and if so a referral will be made.

TWO HIGH ARCHED FEET!
Sometimes this type of surgery needs to be performed on both feet. Due to the extensive nature of the surgery and the amount of postoperative rehabilitation it is not advisable to operate on both feet at the same time. Most times 6 to 12 months have elapsed before the other foot is corrected.

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