Hallux valgus in young patients: comparison of soft-tissue realignment and metatarsal osteotomy

Two procedures of hallux valgus correction in young patients were compared by long-term results: soft-tissue realignment (McBride) and Mitchell osteotomy. From 1970 to 1990, 33 hallux valgus deformities of 17 patients were corrected with one of these procedures at the Orthopaedic Department of the University of Mainz. Patients' age at operation ranged from 9 to 20 years and average follow-up was 16 years later. Reevaluation consisted of subjective criteria, such as pain, shoe-fitting, functional disability and cosmetics and objective parameters (hallux-valgus and intermetatarsal angle, osteoarthrotic changes and range of motion of the metatarsophalangeal joint). They were assessed by report, interview, radiograph and physical examination and determined the overall outcome. McBride procedure showed 59% good, 12% satisfying and 29% dissatisfying long-term results, whereas outcome after Mitchell osteotomy was graded as good in 69%, satisfying in 12% and dissatisfying in 19% of the cases. Critical analysis emerged, that each procedure has its own bounds of indication. Successful hallux valgus correction can be achieved by an individual approach consisting of careful study of the indications, well-performed surgery and appropriate postoperative care.