Clinical results of Mitchell’s osteotomy for treatment of hallux valgus. Study from a Tertiary centre in Kashmir

Abstract

Background: Hallux vulgus means lateral deviation of great toe is in fact a complex deformity of the first ray. The concerns are pain over 1st metatarsophalangeal joint, difficulty in shoe wear and a cosmetically unacceptable deformity. A large number of osteotomies have been described for the correction of Hallux Valgus indicating that no osteotomy is universally acceptable for all patients. Patients and Methods: A total of 56 feet of 40 patients, 6 males and 34 females with Hallux Valgus underwent Mitchell’s Osteotomy and were followed up for at least 18 months. Patients’ age ranged from 20 to 60 years and the duration of follow-up ranged from 18 to 40 months. Postoperative results were assessed based on the recommendations of the American Orthopaedic Foot and Ankle Society, on 5 categories: pain in the first metatarsophalangeal, deformity of the metatarsophalangeal, plantar callosity and/or metatarsalgia of lesser metatarsals, the use of commercially available shoes, and local inflammatory symptoms.Results: Time duration in cast which corresponded with healing of Osteotomy was on an average 8.5 weeks (range 6 to 20 wks). Return to full employment took 15.5 weeks on an average (range 10 to 28 wks). Thirty five of our patients (48 feet) had pain as the predominant reason for surgery. Thirty three (94%) were satisfied with the surgery, two patients had pain on exertion though of less intensity than before. 37(92%) of our patients were satisfied with the appearance of their feet. 38(%) patients were satisfied with their shoe wear. First metatarsal shortening of an average of 4.5 mm (3-11 mm) was noted. Conclusion: Mitchell’s Osteotomy shortens the length of the first metatarsal bone and thus relieves tension in soft tissues and is a good option for treatment of patients with Hallux Valgus