Figure 5 Incomplete correction with residual deformity over a 7-year follow-up. (a) Standing preoperative radiograph showing valgus deformity (abnormal TAS, TC, and MA angles) with symmetrical joint space (normal TT angle), scalloped lateral part of the distal tibial epiphysis and complete fibular physeal arrest. (b) Immediate postoperative AP view radiograph (in cast) showing accepted correction with improved TAS, TC, and MA angles with good coaptation of the osteotomy site with no translation or displacement or syndesmotic disruption (prophylactic syndesmotic screw fixation) after osteotomy. (c) 1-year follow-up radiograph showing early recurrence of the deformity (mostly due to crushed lateral part of the distal tibial physis with continued differential growth with the distal tibial physis itself) in spite of good fixation and completely united osteotomy. (d) 2-years follow-up radiograph after medial malleolar epiphysiodesis (performed as a secondary procedure) to decrease deformity progression. (e) 3-year follow-up radiograph showed improved alignment 1 year following medial malleolar epiphysiodesis. (f) 5-year postoperative radiograph showing preserved and symmetrical joint space with residual valgus deformity indicating that medial epiphysiodesis was not completely effective. (g) 7-years follow-up AP and Mortis view radiograph showing preserved and symmetrical joint space with incompletely corrected deformity. AP, anteroposterior; MA, malalignment; TAS, tibial articular surface; TC, tibiocrural; TT, talar tilt.