Summary:A previously unreported modification to the Cole mid-foot osteotomy is described for correction of rigid equinocavovarus foot deformities. Axial derotation or pronation of the forefoot prior to the second cut of a wedge osteotomy of the anterior tarsus allows for correction of cavus, varus, and associated supination deformity of the foot without creating a lateral rocker, prominent fifth metatarsal base, excessive shortening, or violation of hindfoot articulations. Pronation of the forefoot may exacerbate an existing plantar-flexed first metatarsal bone, which can be corrected by dorsiflexion osteotomy of the first ray, resulting in a mobile plantigrade foot.