Fig. 3.

Medial closing wedge osteotomy and corrective Z-shaped osteotomy of the fibula. a Pre-operative weight-bearing radiographs show post-traumatic valgus tilting of the talus within the mortise and malunion of the fibula with substantial shortening and external rotation. Saltzman view shows the valgus hindfoot alignment. b First, corrective Z-shaped osteotomy of the fibula was performed to achieve elongation of the fibula and derotation as well as an aligned ankle mortise. Then medial closing wedge osteotomy was performed to address the valgus hindfoot deformity. c Post-operative weight-bearing radiographs show completed osseous healing at the site of osteotomies at the 1-year follow-up. Saltzman view shows normal hindfoot alignment. d After hardware removal patient is pain-free with no restrictions of sports activities