Outcome of a Modified Mitchell Osteotomy for Severe Hallux Valgus Deformity

Abstract

Background: The choice of procedure for severe hallux valgus deformity is still a matter of debate.Objective: This study presents the outcome of a distal osteotomy combined with a transarticular release in severe hallux valgusMethods: We reviewed the clinical and radiological results of 38 feet in 33 patients treated with a modified Mitchell osteotomy and a transarticular release for severe hallux valgus. After a median follow up of 36 months (IQR, 27-50 months) clinical outcome data were recorded with FAOS, SF-12, VAS-pain and -disability and AOFAS-HMI scores. Radiological data were collected by analysis of the preoperative and late postoperative weightbearing radiograph.Results: Mean achieved correction in IMA and HVA was respectively 7.1 (p<0.001 95% CI 6.02- 8.1) and 19.5 (p<0,001 16.8-22.8) degrees, which was statistically significant. Median AOFAS-HMI score was 92 (IQR, 83-100). Median total FAOS score was 89 (IQR, 75- 100), median VAS for pain was 3 (IQR, 1-24), median VAS for disability was 10 (IQR, 1-31). Most encountered complications were dorsiflexion restriction and metatarsalgia. Ninety-one percent would choose the same procedure given the outcome.Conclusion: Despite these complications, modified Mitchell osteotomy combined with a transarticular release yields a satisfying outcome after a median follow-up of 36 months in these patients with severe hallux valgus deformity.