Acute Correction of Foot Supination and Forefoot Adduction Deformities Using Midfoot Gigli Saw Osteotomy and Wire Fixation

Introduction: Complex deformities of the pediatric foot are not uncommon, and the surgical treatment is often challenging, in particular when dealing with adduction-supination deformities of the forefoot. Open midfoot osteotomies have been widely used, but have been associated with foot shortening and neurovascular compromise. The purpose of this study was to evaluate the effectiveness of a percutaneous Gigli saw midfoot osteotomy with acute correction.

Methods: Eight patients, 2 females and 6 males aged 5-27 (mean age 15.7) with supination and adduction deformities of the forefoot were included. Two had congenital clubfoot, 2 had arthrogryposis, 1 had constriction band syndrome, 2 had developmental abnormalities and 1 had an acquired deformity. Between 2012 and 2016 they each underwent a percutaneous Gigli saw midfoot osteotomy with acute correction. This was performed using a 4 incision percutaneous approach, with the osteotomy via the cuneiforms and the cuboid. Fixation was performed with crossed Kirschner wires and a plaster cast.

Results: All patients had uneventful radiographic union after 6 weeks and started immediate weight-bearing. All but one of the patients were satisfied with the outcome. There were no incidences of infection or neurovascular injury. Two patients underwent subsequent correction of equinus.

Conclusion: Based on our initial experience, we believe that acute correction by percutaneous Gigli saw midfoot osteotomy may be used as a safe and effective technique in patients with midfoot and forefoot deformities.