'Z' metatarsal osteotomy: modified Mitchell's osteotomy for hallux valgus

The Mitchell's osteotomy is an established and successful operation for hallux valgus. We report a previously undescribed procedure comprising a step or 'Z' osteotomy that is a simplified version of the Mitchell's osteotomy which involves less extensive soft tissue dissection and avoids opening the first metatarsophalangeal (MTP) joint. In total, 51 operations in 40 patients were reviewed with a mean follow-up of 4.7 years. The results were compared with those reported by Mitchell in his paper of 1958, using the same criteria. The mean age was 24 years and 82% of patients were women. In 88% of patients the results were rated excellent or good and there were no serious complications. These results suggest that this procedure is as successful as the Mitchell osteotomy in young patients, and it may have long-term benefits.