Jsmc-10380

OUTCOMES OF MITCHELL’S PROCEDURE IN THE TREATMENT OF HALLUX VALGUS

Omer Ali Rafiq Barawi a, Abdullah K. Ghafour b , and Abd Ali Muhsin c

a Department of Orthopedic Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 

b Shar Teaching Hospitals, Sulaimani, Kurdistan Region, Iraq.

c Department of Orthopedic Surgery,College of Medicine, Al-Nahrain University, Baghdad, Iraq.

Submitted: 27/5/2022; Accepted: 21/10/2022; Published: 21/12/2022

DOI Link: https://doi.org/10.17656/jsmc.10380 

ABSTRACT 

Background 

Hallux Valgus is the commonest foot deformity. It is characterized by lateral deviation of the big toe with the medial shifting of the first metatarsal. Many intrinsic and extrinsic factors are claimed to be a cause and may coexist as multifactorial. Mitchell’s distal metatarsal osteotomy is one of the preliminary operations proposed in managing hallux valgus, with 70% to 90% of satisfactory results.

Objectives 

To evaluate the outcome of Mitchell’s procedure in treating mild to moderate hallux valgus in terms of clinical and radiological outcomes.

Patients and Methods

Sixteen adult patients (26 feet) with mild to moderate hallux valgus were enrolled in this study. They underwent original Mitchell’s step-cut distal osteotomy to correct their hallux valgus

Results

At the last follow-up, overall satisfaction was (81.25%) with three patients unsatisfied due to transfer metatarsagia and reflex sympathetic dystrophy. The mean change in hallux valgus angle and intermetatarsal angle were (17.27°) and (4.47°) respectively. 

Conclusion

Mitchell’s procedure is a distal metatarsal osteotomy which has good results in treating mild to moderate hallux valgus in terms of clinical and radiological appearance and acceptable patient satisfaction. However, transfer metatarsalgia and recurrence of deformity are two more known drawbacks of this procedure.

KEYWORDS

Hallux valgus, Distal metatarsal osteotomy, Mitchell’s procedure, Metatarsalgia.

References 

1. Bowyer G., Uglow M. The ankle and foot. Blom A., Warwick D., Whitehouse M. Apley and Solomon’s System of Orthopaedics and Trauma. 10th Ed. Boca Raton: CRC Press, [2017]: 626 – 629.

2. Morphy G. Disorders of the hallux. Azar F., Beaty J., Canale S. Campbell’s Operative Orthopaedics. 13th Ed. Philadelphia: Elsevier, Inc. [2017]: 3922 – 4012. 

3. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. (September 2010), 27; 3: 21. 

4. Easley M., Tranka H. Current Concepts Review: Hallux Valgus Part 1: Pathomechanics, Clinical Assessment, and Nonoperative Management. Foot Ankle Int (2007), 28: 654.

5. McKean J., Park J. Hallux Valgus [internet]. Orthobullets [May 2016]. Available from: https://www.orthobullets.com/foot-and-ankle/7008/hallux-valgus 

6. Coughlin M., Jones C. Hallux Valgus: Demographics, Etiology, and Radiographic Assessment. Foot Ankle Int (2007), 28: 759.

7. Glynn M., Dunlop J., Patrick D. The Mitchell Distal Metatarsal Osteotomy for Hallux Valgus. J Bone Joint Surg. (May 1980); Vol.62-B, No. 2. 188 – 191. 

8. Kilmartin T., Wallace W. The Aetiology of Hallux Valgus: A Critical Review of the Literature. The Foot (1993) 3. 157 – 167.

9. Mann R., Coughlin M. Hallux Valgus-Etiology, Anatomy, Treatment and Surgical Considerations. Clinical Orthopedics Related Research. (June 1981) No. 157: 31 – 41. 

10. Steel M. 3rd, Johnson K., DeWitz M., IIstrup D. Radiographic Measurements of the Normal Adult Foot. Foot Ankle. (November 1980) 1(3): 151- 158. 

11. Saltzman CL, Brands EA, Berbaum KS, DeGnore L, Holmes JR, Katcherian DA, Teasdall RD, Alexander IJ. Reliability of Standard Foot Radiographic Measurements. Foot Ankle Int. (December 1994) 15(12): 661-665. 

12. Coughlin M., Saltzman C. and Nunley J. Angular Measurements in the Evaluation of Hallux Valgus Deformities: A Report of the Ad Hoc Committee of the American Orthopædic Foot & Ankle Society on Angular Measurements. Foot Ankle Int (January 2002) 23: 68 – 74. 

13. Coull R., Stephens M. Operative decision making in hallux valgus. Current Orthopaedics (2002) 16, 180 – 186. 

14. Robinson A., Limbers J. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg [Br] (August 2005); 87-B: 1038-1045 

15. Merkel K., Katoh Y., Johnson J., Chao E. Mitchell Osteotomy for Hallux Valgus: Long-term Follow-up and Gait Analysis. Foot & Ankle (1983) Vol. 3, No.4: 189 – 196. 

16. Blum JL. The modified Mitchell osteotomy-bunionectomy: indications and technical considerations. Foot Ankle Int. (March 1994)15(3): 103-106. 

17. Shapiro R., Heller L. The Mitchell Distal Metatarsal Osteotomy in The Treatment of Hallux Valgus. Clinical Orthopaedics. And Related Research (March 1975) No. 107: 226 – 231 

18. Dermon A., Tilkeridis C., Lyras D., Tryfonidis M., Petrou C., Tzanis S., Kazakos K., Petrou G. Long-term Results of Mitchell’s Procedure for Hallux Valgus Deformity: A 5- to 20-year Follow-up in 204 Cases. Foot & Ankle International. (January 2009) Vol. 30, No. 1; 16 -20.

19. Baba A., Bhat J., Paljor S., Mir N. and Majid S. Mitchell's osteotomy in managing hallux valgus: An Indian perspective. Indian J Orthop. 2009 Jan-Mar; 43(1): 76–81.

20. Kalender A., Uslu M., Bakan B., Ozkan F., Erturk C Altay M., Guner S. and Kalender M. Mitchell’s Osteotomy with Mini-Plate and Screw Fixation for Hallux Valgus. Foot & Ankle International (2013) Vol. 34 No.2: 238– 243. 

21. McDonald M., Stevens D. Modified Mitchell Bunionectomy for Management of Adolescent Hallux Valgus. Clinical Orthopaedics , and Related Research (November 1996) No. 332: 163-169 

22. David-West K. Complications associated with Mitchell’s Osteotomy for Hallux Valgus Correction: A retrospective hospital review. The Foot and Ankle Online Journal (March 2011): vol. (4) No. (3). 

23. Prior T., Grace D., MacLeanJ., Allen P., Chapman G., Day A. Correction of hallux abductus valgus by Mitchell’s metatarsal osteotomy: comparing standard fixation methods with absorbable polydioxanone pins. The Foot (1997) No.7: 121-125. 

24. Canale P., Aronsson D., Lamont R., Manoli A. The Mitchell Procedure for the Treatment of Adolescent Hallux Valgus-A Long-Term Study. J Bone Joint Surg (November 1993), Vol.75-A, No.11. 1610 – 1618 

25. Calder J., Hollingdale J., Pearse M. Screw versus suture fixation of Mitchell’s osteotomy: A Prospective, Randomised Study. J Bone Joint Surg [Br] 1999; 81-B: 621-624. 

26. Coughlin M., Mann R. Hallux Valgus. Coughlin M., Mann R., Saltzman C. Surgery of The Foot and Ankle. 8Th Ed. Vol 11, by Mosby, Inc., an affiliate of Elsevier Inc. [2007]: 183 – 362).

Full Text

 © The Authors, published by University of Sulaimani, College of Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.