Modified Mitchell's osteotomy for moderate to severe hallux valgus--an outcome study

The purpose of this study was to evaluate the outcome of a modified technique of Mitchell's osteotomy for treatment of moderate to severe hallux valgus deformity with the aims of reducing first metatarsal shortening and osteonecrosis. Between February 2001 and December 2007, a total of 69 patients (90 feet) underwent Mitchell's corrective osteotomy for moderate to severe hallux valgus deformity. Mean duration of follow-up after surgery was 37 months. Clinical outcome was assessed using the AOFAS Hallux Metatarsophalangeal-Interphalangeal score preoperatively; at 6 weeks, 6 months, 12 months postoperatively; and at annual follow-ups thereafter. Standard weight-bearing radiographs were obtained at each visit. Fifty-nine patients (80/90 feet, 89%) were completely satisfied, whereas 10 patients (10/90 feet, 11%) were satisfied with minor reservations owing to minor complications. Global AOFAS score improved from 43.7 (range, 20 to 77) preoperatively to 85.4 (range, 55 to 100) at final follow-up (P < .01). Eighty-eight (98%) of 90 feet were completely pain free. There was a statistically significant improvement in mean hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle at final follow-up. There were no cases of deep infection, nonunion, or osteonecrosis of first metatarsal head. None of the patients had shortening of the first metatarsal bone by more than 3 mm. In conclusion, our modified surgical technique with a combination of bony correction and adequate capsular reefing is a simple procedure to correct moderate to severe hallux valgus deformity that results in high levels of patient satisfaction, successful deformity correction, and controlled shortening of the first metatarsal, as well as minimal recurrence of deformity.).