The purpose of this study was to elucidate the specific radiographic effects that the Cotton osteotomy confers when used in combination with other reconstructive procedures in the management of the flexible flat foot deformity. Between 2002–2013, 198 Cotton osteotomies were retrospectively identified following IRB approval. 131 were excluded on the basis of ipsilateral mid/hindfoot arthrodesis, inadequate radiographs or being less than 18yrs old at time of surgery. Parameters including the articular surface angles of the hindfoot/forefoot, Meary's angle and a newly defined Medial Arch Sag Angle (MASA) were recorded. A matched group of patients who did not undergo a Cotton osteotomy but who underwent similar hindfoot reconstructive procedures served as historic controls.Introduction:
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