Classical Mitchell's osteotomy in the management of symptomatic hallux vulgus
Keywords:Hallux vulgus, Osteotomy, Mittchell’s osteotomy
Background: Hallux vulgus is common deformity of fore foot frequently resulting in pain at first metatarso phalyngeal joint and cosmetic problems. Hallux vulgus is particularly more common in shoe wearing populations. Ours being a sub Himalayan region with harsh and prolonged winters where shoe wearing is a must this condition is very common. Various surgical procedures have been described for its management. These range from soft tissue procedures to arthodesis of first metatarso phalyngeal joint. Distal first metatarsal osteotomy (Mitchell’s osteotomy) is a time tested procedure in its management.
Methods: Forty adult patients (56 feet) with symptomatic hallux vulgus, who did not respond to conservative treatment, were managed with Mitchell’s osteotomy.
Results: Results were assessed as per American Orthopaedic Foot and Ankle Society grading. More than ninety percent of our patients were fully satisfied with their pain relief and foot cosmetics while others were satisfied with some reservations. There was no major complication or non-union at osteotomy site.
Conclusions: Management of hallux vulgus is conservative to begin with, measures like life style modifications, broad toed shoes, toe spacers and physical therapy are tried first. Surgical intervention is indicated if conservative measures fail to relieve symptoms. More than 130 surgical procedures have been described for hallux vulgus ranging from soft tissue procedures like MacBride’s to arthodesis of first metatarso phalyngeal joint. Distal metatarsal osteotomy was first described by Hawkins in 1945 but was named after Mitchell who published his work in 1958. From our study we conclude that this is a time tested procedure for symptomatic cases of Hallux Vulgus not responding to conservative measures.
Terry Canale S, Beaty JH. Campbell’s operative orthopaedics. 4th volume. Chapter 78. 10th edition. Disorders of hallux. Canada: Elsevier; 2012: 3915.
Zaheer M, Dahabra I. Modified Mitchell’s Osteotomy for the Treatment of Hallux Vulgus. Experience at King Hussein Medical Center. JRMS. 2003;10(2):6-10.
Sin-Fook, Hodgson A. A comparison of foot forms among the non-shoe wearing Chinese population. J Bone Joint Surg Am. 1958;40:1058-62.
Hueter C. Klinik der Gelenkkrankheiten mit Einschluss der Orthopadie. 3rd edition. St. Louis: CV Mosby; 1973: 1870-1871.
McBride E. Hallux vulgus, bunion deformity: its treatment in mild, moderate and severe stages. J Int Coll Surg. 1954;21:99.
Hawkins FB, Mitchell CL, Hedrick DW. Correction of Hallux Vulgus by metatarsal osteotomy. JBJS. 1945;27:387-94.
Mitchell CL, Fleming JL, Allen R, Glenney C, Sanford GA. Osteotomy-bunionectomy for Hallux Vulgus. JBJS [Am]. 1958;40:41-60.
Smith RW, Reynolds C, Stewart MJ. Hallux vulgus; report of Research Committee American Orthopaedic Foot and Ankle Society. Foot Ankle. 1984;5(2):90-103.
Reverdin J. On the outward deviation of great toe (hallux vulgus, bunions, balloons) and its surgical treatment. Trans Int Med Cong. 188;2:408.
Piggot H. The natural history of hallux vulgus in adolescence and early adult life. J Bone and Joint Surgery [Br]. 1960;42:749-60.
Mann R, Hagy J. The function of the toes in walking, jogging and running. Clin Orthop Related Res. 1979;142:24.
Richardson GE, Donley B. Disorders of the hallux. In: Canale ST, editor. Campbell’s operative orthopaedics. 9th edition. Missouri: Mosby; 1998: 1624.
Helal B, Gupta SK, Gojaseni P. Surgery for adolescent hallux vulgus. Acta Orthop Scand. 1974;45;271-95.
Turbull T, Grange WJ. A comparison of Keller’s arthoplasty and distal metatarsal osteotomy in the treatment of adult hallux vulgus. J Bone and Joint Surgery [Br]. 1986;68:132-7.
Wu KK. Modified Mitchell’s bunionectomy (Wu’s bunienectomy). Orthopaedics. 1997;20;253-7.
Briggs TWR, Smith P, McAuliffe. Mitchell’s Osteotomy Using Internal Fixation and Early Mobilization. JBJS [Br]. 1992;74:137-9.
Calder JD, Hollingdale JP. Measurement of strength and stability of suture versus AO screw fixation of Mitchell’s osteotomy: A cadaveric study. Foot. 1997;7:220-3.
Calder JD, Hollingdale JP, Pearse MF. Screw fixation versus suture fixation of Mitchell’s osteotomy; A prospective, randomised study. J Bone and Joint Surgery Br. 1999;81;621-4.
Glynn MK, Dunlop JB, FitzPatrick D. The Mitchell distal metatarsal osteotomy for hallux vulgus. J of Bone Joint Surg. 1980;62(2):188-91.
Merkel KD, Katoh Y, Jonhson EW, Chao EY. Mitchell Osteotomy for hallux valgus: Long term follow-up and gait analysis. Foot Ankle. 1983;3:189-96.
Broughton V, Winson IG. Keller’s arthroplasty and Mitchell’s osteotomy: A comparison with first metatarsal osteotomy of the long term results for Hallux Vulgus deformity in younger female. Foot Ankle. 1988;10:201-5.