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. 2021 Apr 14:65:102259.
doi: 10.1016/j.amsu.2021.102259. eCollection 2021 May.

Modified Mitchell technique for treating hallux valgus: Retrospective case series on a Middle-Eastern population and literature review

Rami Ayoubi  1 , Mohammad Darwish  1 , Dany Aouad  1 , Joseph Maalouly  1 , Jason Hanna  1 , Ghadi Abboud  2 , Chawki Cortbawi  1
Affiliations

Modified Mitchell technique for treating hallux valgus: Retrospective case series on a Middle-Eastern population and literature review

Rami Ayoubi et al. Ann Med Surg (Lond). .

Abstract

Introduction: The hallux valgus deformity is a complex deformity of the first ray of the foot, with more than 100 procedures developed for its treatment. The aim of this retrospective study was to assess the clinical and radiographic outcomes of a modified Mitchell's technique.

Methods: Between 2007 and 2018, 75 patients underwent the procedure. Clinical results were assessed by the AOFAS score. Radiological studies were evaluated by measuring pre-operative and post-operative HVA and IMA angles as well as the relative shortening of the first metatarsal.

Results: Of the initial 75 patients, 42 patients remained eligible with a total of 67 feet. The mean age and follow-up were 47.8 and 5.2 years respectively. Global AOFAS score improved from 45.3 to 88.8 (p < 0.01). Mean HVA and IMA improved from 37.0 to 10.2 (p < 0,01) and 12.1 to 5.6 (p < 0.01), respectively. The mean metatarsal shortening was 3.0 mm (p < 0.01). The statistical analysis showed no significant correlation between preoperative HVA and IMA angles with postoperative shortening, metatarsalgia, AOFAS scores nor the difference between the preoperative and postoperative AOFAS scores.

Conclusion: Short- and long-term outcomes of this modified Mitchell's osteotomy have been reported. Compared to other studies, these modifications proved to result in very good clinical and radiological outcomes even in severe cases with HVA>40. It has shown to be reliable, reproducible, and cost-efficient with low complication rates. We would like to highlight the importance of proper patient selection, limited soft tissue stripping, and adherence to the proposed surgical steps to avoid unwanted complications.

Keywords: Foot surgery; Hallux valgus; Modified Mitchell's osteotomy.

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Conflict of interest statement

The authors declare no conflict of interest regarding the publication of this article.

Figures

Fig. 1
Fig. 1
a) Hallux valgus deformity; b) medial exostosis resection c) proximal complete and distal incomplete osteotomies; d) lateral translation of the distal fragment; e) fixation by K-wire; f) bone grafting of the previously excised bunion into the lateral aspect of the cut, with excision and smoothening of the medial protruding edge.
Fig. 2
Fig. 2
Viewed medially, the cut is made slightly oblique by orienting the cut from distal-dorsal to proximal-volar.
Fig. 3
Fig. 3
Superiorly observed lateral translation of the distal fragment, with fixation by a single K-wire.
Fig. 4
Fig. 4
Medial capsulorrhaphy is done by anchoring and tightening of the capsule to the medially protruding K-wire.
See this image and copyright information in PMC

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