Clinical application research of three-dimensional printed patient-specific cutting guides in Cole midfoot osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Zhiyuan , QIN Boquan ^{共同第一作者} , LI Jia , YIN Shijiu , REN Yi , CHEN Yu , LIU Xi ,  ZHANG Hui

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

ZHANG Hui, Email: zhanghui1437@wchscu.cn

Keywords：

Pes cavus; Cole midfoot osteotomy; three-dimensional technique; personalized navigation plate

DOI：

10.7507/1002-1892.202510006

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Objective To evaluate effectiveness of three-dimensional (3D) printed patient-specific cutting guides (PSCGs) in Cole midfoot osteotomy for treatment of rigid pes cavus deformity associated with Charcot-Marie-Tooth (CMT) disease, and to analyze learning curve for PSCGs-assisted surgery. Methods A retrospective analysis was conducted of 20 patients (40 feet) with rigid pes cavus deformity associated with CMT who were admitted between March 2021 and July 2023 and met the inclusion criteria. The cohort comprised 13 men and 7 women, with ages ranging from 17 to 62 years (mean, 37.3 years). All patients underwent whole-genome sequencing, which identified 17 patients with CMT type 1 and 3 patients with CMT type 2. Preoperatively, 3D models of bilateral feet were reconstructed based on CT data, and PSCGs were designed and fabricated accordingly. All patients underwent a Cole midfoot osteotomy assisted by the guides. Operation time, number of intraoperative fluoroscopic exposures, and intraoperative complications were recorded. Pre- and post-operative outcomes were compared using the visual analogue scale (VAS) score for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and domain scores of the 36-Item Short Form Health Survey (SF-36), as well as radiographic parameters including the Meary’s angle, Pitch angle, talo-first metatarsal angle (T1MT), talocalcaneal angle (TCA), and Djian-Annonier angle, to assess the corrective effect of the osteotomy. A modified cumulative sum analysis was performed to evaluate the learning curve for PSCGs-assisted surgery. Results All procedures in the 20 patients (40 feet) were completed successfully, with no cases of massive hemorrhage or injury to critical neurovascular or tendinous structures. The operation time ranged from 63 to 129 minutes (mean, 82.9 minutes), and fluoroscopy was performed 2-11 times (mean, 4.7 times). Postoperatively, 1 patient (1 foot) developed a mild superficial surgical-site infection, which resolved with symptomatic treatment; no deep infections occurred. All patients were followed up 8-43 months (mean, 17 months). At last follow-up, the AOFAS ankle-hindfoot score and all domain scores of the SF-36 were significantly higher than preoperative values, and the VAS score, the Meary’s angle, T1MT, TCA, and Djian-Annonier angle significantly decreased, Pitch angle significantly increased (P<0.05). The imaging confirmed osteotomy union in all feet, and no fixation-related complications was observed. Learning-curve analysis indicated that both operation time and fluoroscopy usage plateaued after the 13th case, suggesting stabilization of surgical performance from that point onward. Conclusion The use of PSCGs during Cole midfoot osteotomy enables precise and efficient correction of complex midfoot deformities while significantly reducing intraoperative fluoroscopic exposure. Moreover, this technique appears to have a short learning-curve and good reproducibility, which may facilitate its broader adoption in clinical practice.

Citation： ZHANG Zhiyuan, QIN Boquan, LI Jia, YIN Shijiu, REN Yi, CHEN Yu, LIU Xi, ZHANG Hui. Clinical application research of three-dimensional printed patient-specific cutting guides in Cole midfoot osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(4): 571-577. doi: 10.7507/1002-1892.202510006 Copy

1.	Qin B, Wu S, Zhang H. Evaluation and management of cavus foot in adults: a narrative review. J Clin Med, 2022, 11(13): 3679. doi: 10.3390/jcm11133679.
2.	Akoh CC, Phisitkul P. Clinical examination and radiographic assessment of the cavus foot. Foot Ankle Clin, 2019, 24(2): 183-193.
3.	Aminian A, Sangeorzan BJ. The anatomy of cavus foot deformity. Foot Ankle Clin, 2008, 13(2): 191-198.
4.	Myerson MS, Myerson CL. Cavus foot: deciding between osteotomy and arthrodesis. Foot Ankle Clin, 2019, 24(2): 347-360.
5.	Perera A. Advances in minimally invasive surgery of the foot and ankle-percutaneous, arthroscopic, and endoscopic operative techniques. Foot Ankle Clin, 2016, 21(3): xiii-xiv. doi: 10.1016/j.fcl.2016.06.001.
6.	Haupt ET, Porter GM, Blough C, et al. Outcomes of Charcot-Marie-Tooth disease cavovarus surgical reconstruction. Foot Ankle Int, 2024, 45(11): 1175-1183.
7.	Ergun S, Yildirim Y. The Cole midfoot osteotomy: clinical and radiographic retrospective review of five patients (six feet) with different etiologies. J Am Podiatr Med Assoc, 2019, 109(3): 180-186.
8.	秦博泉. 中足Cole截骨矯正僵硬性高弓足的臨床研究及個體化定制截骨導板設計. 成都: 四川大學, 2021.
9.	Nakamura S, Crowninshield RD, Cooper RR. An analysis of soft tissue loading in the foot—a preliminary report. Bull Prosthet Res, 1981, 10-35: 27-34.
10.	Okamoto Y, Takashima H. The current state of Charcot-Marie-Tooth disease treatment. Genes (Basel), 2023, 14(7): 1391. doi: 10.3390/genes14071391.
11.	De Grado A, Serio M, Saveri P, et al. Charcot-Marie-Tooth disease: a review of clinical developments and its management—What’s new in 2025? Expert Rev Neurother, 2025, 25(4): 427-442.
12.	帕爾哈提·瓦哈甫, 劉偉, 王雪, 等. 3D打印截骨導板結合Ilizarov技術在僵硬型馬蹄內翻足治療中的生物力學特性與臨床應用. 中國修復重建外科雜志, 2025, 39(8): 994-1001.
13.	Morena J, Gupta A, Hoyle JC. Charcot-Marie-Tooth: From molecules to therapy. Int J Mol Sci, 2019, 20(14): 3419. doi: 10.3390/ijms20143419.
14.	Dagneaux L, Canovas F. 3D printed patient-specific cutting guide for anterior midfoot tarsectomy. Foot Ankle Int, 2020, 41(2): 211-215.
15.	Burssens A, Barg A, van Ovost E, et al. The hind- and midfoot alignment computed after a medializing calcaneal osteotomy using a 3D weightbearing CT. Int J Comput Assist Radiol Surg, 2019, 14(8): 1439-1447.
16.	Bosma SE, Wong KC, Paul L, et al. A cadaveric comparative study on the surgical accuracy of freehand, computer navigation, and patient-specific instruments in joint-preserving bone tumor resections. Sarcoma, 2018, 2018: 4065846. doi: 10.1155/2018/4065846.
17.	Sobrón FB, Dos Santos-Vaquinhas A, Alonso B, et al. Technique tip: 3D printing surgical guide for pes cavus midfoot osteotomy. Foot Ankle Surg, 2022, 28(3): 371-377.
18.	Michalski MP, Blough CL, Song JH, et al. Méary’s angle decoded: 3D analysis of first ray plantarflexion deformity in Charcot-marie-tooth disease. Foot Ankle Surg, 2025, 31(2): 143-147.
19.	Xie HQ, Xie HT, Luo T, et al. Design of 3D printing osteotomy block for foot based on triply periodic minimal surface. Sci Rep, 2024, 14(1): 15851. doi: 10.1038/s41598-024-65318-4.
20.	Mathieu J, Lamouroux G, Gatti M, et al. Can anterior midfoot tarsectomy procedure be improved using patient-specific cutting guide? An experimental study. Orthop Traumatol Surg Res, 2025, 17: 104433. doi: 10.1016/j.otsr.2025.104433.
21.	Kim J, Ellis S, Carrino JA. Weight-bearing computed tomography of the foot and ankle-what to measure? Clin Podiatr Med Surg, 2024, 41(4): 775-796.
22.	Kavak S, Ozturk B, Ogut T, et al. Application of patient-specific surgical guides in foot and ankle surgery. Acta Orthop Traumatol Turc, 2025, 59(6): 340-348.
23.	Zhou Y, Zhou B, Liu J, et al. A prospective study of midfoot osteotomy combined with adjacent joint sparing internal fixation in treatment of rigid pes cavus deformity. J Orthop Surg Res, 2014, 9: 44. doi: 10.1186/1749-799X-9-44.
24.	Naudi S, Dauplat G, Staquet V, et al. Anterior tarsectomy long-term results in adult pes cavus. Orthop Traumatol Surg Res, 2009, 95(4): 293-300.
25.	Simon AL, Seringe R, Badina A, et al. Long term results of the revisited Meary closing wedge tarsectomy for the treatment of the fixed cavo-varus foot in adolescent with Charcot-Marie-Tooth disease. Foot Ankle Surg, 2019, 25(6): 834-841.
26.	Bouchard M, Da Costa S, Peel B. Deformity-correcting ankle fusions with patient-specific 3D operative planning and 3D-printed cut guides: report of 2 cases. JBJS Case Connect, 2022, 12(4). doi: 10.2106/JBJS.CC.22.00553.
27.	Liu W, Zhang S, Zhang W, et al. Clinical application of 3D printing-assisted patient-specific instrument osteotomy guide in stiff clubfoot: preliminary findings. J Orthop Surg Res, 2023, 18(1): 843. doi: 10.1186/s13018-023-04341-z.
28.	Stimolo D, Leggieri F, Matassi F, et al. Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study. Innov Surg Sci, 2024, 9(3): 123-131.
29.	Mustafa MS, Dierking G, Ivoc J, et al. Accuracy of patient-specific instrument resections in vivo in total ankle arthroplasty on postoperative weightbearing CT scan. Foot Ankle Orthop, 2025, 10(2): 24730114251338258. doi: 10.1177/24730114251338258.
30.	Zhang C, Lin Y, Yang L, et al. 3D printing-assisted supramalleolar osteotomy for ankle osteoarthritis. ACS Omega, 2022, 7(46): 42191-42198.
31.	Pang R, Jiang Z, Xu C, et al. Is patient-specific instrumentation accurate and necessary for open-wedge high tibial osteotomy? A meta-analysis. Orthop Surg, 2023, 15(2): 413-422.

1. Qin B, Wu S, Zhang H. Evaluation and management of cavus foot in adults: a narrative review. J Clin Med, 2022, 11(13): 3679. doi: 10.3390/jcm11133679.
2. Akoh CC, Phisitkul P. Clinical examination and radiographic assessment of the cavus foot. Foot Ankle Clin, 2019, 24(2): 183-193.
3. Aminian A, Sangeorzan BJ. The anatomy of cavus foot deformity. Foot Ankle Clin, 2008, 13(2): 191-198.
4. Myerson MS, Myerson CL. Cavus foot: deciding between osteotomy and arthrodesis. Foot Ankle Clin, 2019, 24(2): 347-360.
5. Perera A. Advances in minimally invasive surgery of the foot and ankle-percutaneous, arthroscopic, and endoscopic operative techniques. Foot Ankle Clin, 2016, 21(3): xiii-xiv. doi: 10.1016/j.fcl.2016.06.001.
6. Haupt ET, Porter GM, Blough C, et al. Outcomes of Charcot-Marie-Tooth disease cavovarus surgical reconstruction. Foot Ankle Int, 2024, 45(11): 1175-1183.
7. Ergun S, Yildirim Y. The Cole midfoot osteotomy: clinical and radiographic retrospective review of five patients (six feet) with different etiologies. J Am Podiatr Med Assoc, 2019, 109(3): 180-186.
8. 秦博泉. 中足Cole截骨矯正僵硬性高弓足的臨床研究及個體化定制截骨導板設計. 成都: 四川大學, 2021.
9. Nakamura S, Crowninshield RD, Cooper RR. An analysis of soft tissue loading in the foot—a preliminary report. Bull Prosthet Res, 1981, 10-35: 27-34.
10. Okamoto Y, Takashima H. The current state of Charcot-Marie-Tooth disease treatment. Genes (Basel), 2023, 14(7): 1391. doi: 10.3390/genes14071391.
11. De Grado A, Serio M, Saveri P, et al. Charcot-Marie-Tooth disease: a review of clinical developments and its management—What’s new in 2025? Expert Rev Neurother, 2025, 25(4): 427-442.
12. 帕爾哈提·瓦哈甫, 劉偉, 王雪, 等. 3D打印截骨導板結合Ilizarov技術在僵硬型馬蹄內翻足治療中的生物力學特性與臨床應用. 中國修復重建外科雜志, 2025, 39(8): 994-1001.
13. Morena J, Gupta A, Hoyle JC. Charcot-Marie-Tooth: From molecules to therapy. Int J Mol Sci, 2019, 20(14): 3419. doi: 10.3390/ijms20143419.
14. Dagneaux L, Canovas F. 3D printed patient-specific cutting guide for anterior midfoot tarsectomy. Foot Ankle Int, 2020, 41(2): 211-215.
15. Burssens A, Barg A, van Ovost E, et al. The hind- and midfoot alignment computed after a medializing calcaneal osteotomy using a 3D weightbearing CT. Int J Comput Assist Radiol Surg, 2019, 14(8): 1439-1447.
16. Bosma SE, Wong KC, Paul L, et al. A cadaveric comparative study on the surgical accuracy of freehand, computer navigation, and patient-specific instruments in joint-preserving bone tumor resections. Sarcoma, 2018, 2018: 4065846. doi: 10.1155/2018/4065846.
17. Sobrón FB, Dos Santos-Vaquinhas A, Alonso B, et al. Technique tip: 3D printing surgical guide for pes cavus midfoot osteotomy. Foot Ankle Surg, 2022, 28(3): 371-377.
18. Michalski MP, Blough CL, Song JH, et al. Méary’s angle decoded: 3D analysis of first ray plantarflexion deformity in Charcot-marie-tooth disease. Foot Ankle Surg, 2025, 31(2): 143-147.
19. Xie HQ, Xie HT, Luo T, et al. Design of 3D printing osteotomy block for foot based on triply periodic minimal surface. Sci Rep, 2024, 14(1): 15851. doi: 10.1038/s41598-024-65318-4.
20. Mathieu J, Lamouroux G, Gatti M, et al. Can anterior midfoot tarsectomy procedure be improved using patient-specific cutting guide? An experimental study. Orthop Traumatol Surg Res, 2025, 17: 104433. doi: 10.1016/j.otsr.2025.104433.
21. Kim J, Ellis S, Carrino JA. Weight-bearing computed tomography of the foot and ankle-what to measure? Clin Podiatr Med Surg, 2024, 41(4): 775-796.
22. Kavak S, Ozturk B, Ogut T, et al. Application of patient-specific surgical guides in foot and ankle surgery. Acta Orthop Traumatol Turc, 2025, 59(6): 340-348.
23. Zhou Y, Zhou B, Liu J, et al. A prospective study of midfoot osteotomy combined with adjacent joint sparing internal fixation in treatment of rigid pes cavus deformity. J Orthop Surg Res, 2014, 9: 44. doi: 10.1186/1749-799X-9-44.
24. Naudi S, Dauplat G, Staquet V, et al. Anterior tarsectomy long-term results in adult pes cavus. Orthop Traumatol Surg Res, 2009, 95(4): 293-300.
25. Simon AL, Seringe R, Badina A, et al. Long term results of the revisited Meary closing wedge tarsectomy for the treatment of the fixed cavo-varus foot in adolescent with Charcot-Marie-Tooth disease. Foot Ankle Surg, 2019, 25(6): 834-841.
26. Bouchard M, Da Costa S, Peel B. Deformity-correcting ankle fusions with patient-specific 3D operative planning and 3D-printed cut guides: report of 2 cases. JBJS Case Connect, 2022, 12(4). doi: 10.2106/JBJS.CC.22.00553.
27. Liu W, Zhang S, Zhang W, et al. Clinical application of 3D printing-assisted patient-specific instrument osteotomy guide in stiff clubfoot: preliminary findings. J Orthop Surg Res, 2023, 18(1): 843. doi: 10.1186/s13018-023-04341-z.
28. Stimolo D, Leggieri F, Matassi F, et al. Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study. Innov Surg Sci, 2024, 9(3): 123-131.
29. Mustafa MS, Dierking G, Ivoc J, et al. Accuracy of patient-specific instrument resections in vivo in total ankle arthroplasty on postoperative weightbearing CT scan. Foot Ankle Orthop, 2025, 10(2): 24730114251338258. doi: 10.1177/24730114251338258.
30. Zhang C, Lin Y, Yang L, et al. 3D printing-assisted supramalleolar osteotomy for ankle osteoarthritis. ACS Omega, 2022, 7(46): 42191-42198.
31. Pang R, Jiang Z, Xu C, et al. Is patient-specific instrumentation accurate and necessary for open-wedge high tibial osteotomy? A meta-analysis. Orthop Surg, 2023, 15(2): 413-422.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application research of three-dimensional printed patient-specific cutting guides in Cole midfoot osteotomy

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