Forefoot Deformities Research Articles

The impact of hindfoot deformities for the recurrence of hallux valgus after joint-preserving surgeries for rheumatoid forefoot deformities

BackgroundRecurrence of hallux valgus (HV) is a common complication after forefoot surgery for rheumatoid forefoot deformities. The aim of this study is to evaluate the impact of hindfoot malalignment on recurrence. MethodsThis was a retrospective observational study designed to analyze the radiographic outcomes of 87 feet in 64 patients with rheumatoid arthritis treated with a joint-preserving surgery for HV deformity. Differences in hindfoot alignment preoperatively between the recurrence and nonrecurrence groups was compared. ResultsThere were no significant differences in hindfoot alignment preoperatively between groups. To estimate the impact of technical problems, the HV and intermetatarsal angles measured from radiographs 3 months postoperatively were compared between groups. The HV angles in the recurrence group were significantly larger than those in the nonrecurrence group (p=0.02). ConclusionsThere were no significant differences between preoperative hindfoot malalignment and postoperative recurrence of HV in rheumatoid forefoot surgeries.

Treatment of the overriding fifth toe: Butler's arthroplasty is a good option.

PurposeThe overriding fifth toe is a congenital triplane deformity that may cause aesthetic and functional concerns in children and adolescents. This study aims to evaluate the results obtained when using Butler’s arthroplasty to treat this forefoot deformity.MethodsWe performed a retrospective study, including all patients undergoing Butler’s arthroplasty from January 1995 to December 2012. Clinical records were reviewed to determine age at date of surgery, gender, laterality, preoperative symptoms, success of deformity correction, postoperative pain, scarring, need for adapted shoe, rates of complications and recurrence. Patient satisfaction was evaluated through a telephone interview. All p-values < 0.05 were considered statistically significant.ResultsA total of 21 patients were included in this study, the majority of which were male (57%), with a mean follow-up of 12 months (1 to 52). In the evaluation of the residual deformity (18 patients), 72% had excellent results, 17% good and 11% poor results. One patient had a keloid scar, three patients reported pain and three patients required adapted footwear. There was a partial recurrence of the deformity in three cases. The majority of patients (78%) were satisfied with the surgery. There was no statistically significant difference in terms of results, when comparing patients older and younger than seven years of age (p = 0.46).ConclusionsButler’s operation is effective and safe in the treatment of the overriding fifth toe, yielding good functional results and patient satisfaction, with low rate of complications.Level of EvidenceIV

Distances from the deep plantar arch to the lesser metatarsals at risk during osteotomy: a fresh cadaveric study

BackgroundThe deep plantar arch is formed by anastomosis of the lateral and deep plantar arteries. Osteotomy of the lesser metatarsals is often used to treat metatarsalgia and forefoot deformity. Although it is known that some blood vessels supplying the lesser metatarsals are prone to damage during osteotomy, there is little information on the distances between the deep plantar arch and the three lesser metatarsals. The aims of this study were to identify the distances between the deep plantar arch and the lesser metatarsals and to determine how osteotomy could damage the arch.MethodsEnhanced computed tomography scans of 20 fresh cadaveric feet (male, n = 10; female, n = 10; mean age 78.6 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery, and the distance from the deep plantar arch to each lesser metatarsal was measured on axial and sagittal images.ResultsThe shortest distances from the deep plantar arch to the second, third, and fourth metatarsals in the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The shortest distances from the distal epiphysis to a line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal in the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the tarsometatarsal joint were 23.0, 21.0, and 18.6 mm. The deep plantar arch ran at the level of the middle third, within the proximal portion of this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) specimens, respectively, and at the level of the proximal third in 9/20 (45.0%), 13/20 (65.0%), and 11/16 (68.8%).ConclusionsOverpenetration into the medial and plantar aspect of the second metatarsal or the proximal and plantar aspect of the fourth metatarsal during shaft or proximal osteotomy could easily damage the deep plantar arch. Shaft or proximal osteotomy approximately 45–47 mm proximal to the distal epiphysis or 18–23 mm distal to the tarsometatarsal joint on the plantar aspect could interrupt blood flow in the deep plantar arch.

Entry points of nutrient arteries at risk during osteotomy of the lesser metatarsals: a fresh cadaveric study

BackgroundOsteotomies of the lesser (second to fourth) metatarsals are often used to correct forefoot deformities. However, certain areas of the lesser metatarsals where arteries may be prone to damage during surgery, and the resulting nonunion and delayed union could cause serious problems. This study sought to identify the nutrient arteries of the lesser metatarsals and to determine how osteotomy could injure these vessels.MethodsEnhanced computed tomography scans of 21 ft (male, n = 10; female, n = 11; mean age 78.6 years at the time of death) were assessed. Twenty-one lower limbs in 21 cadaveric specimens were injected with barium via the external iliac artery, and the points at which the nutrient arteries entered the lesser metatarsals were identified on axial and coronal images.ResultsEach nutrient artery entered the lateral or medial plantar aspect of the lesser metatarsal in the middle third (just proximal to the middle point of the metatarsal) or proximal third obliquely from a distal direction. The mean ± standard deviation (SD) distances from the dorsal plane of the second, third, and fourth metatarsals to the point of entry of the nutrient artery in the axial plane were 8.2 ± 1.5, 7.6 ± 1.2, and 7.6 ± 1.5 mm, respectively. The mean ± SD distances from the distal epiphysis to the point of entry of the nutrient artery into the second, third, and fourth metatarsals in the coronal plane were 3.3 ± 1.1, 3.1 ± 1.0, and 2.8 ± 1.2 mm, respectively. The mean ± SD distances from the distal epiphysis to the point of entry of the nutrient artery into the second, third, and fourth metatarsals in the coronal plane were 46.0 ± 5.2, 40.9 ± 2.6, and 39.1 ± 3.7 mm, respectively. The mean ± SD distances from the proximal epiphysis to the entry point of the nutrient artery into the second, third, and fourth metatarsals in the coronal plane were 23.8 ± 4.7, 25.8 ± 4.3, and 25.0 ± 3.2 mm, respectively.ConclusionsDistal metatarsal osteotomies might be safer than shaft or proximal osteotomy to avoid disruption of the nutrient artery, leading to delayed consolidation of the osteotomy and nonunion.

Acute compartment syndrome of the foot: a review

Acute compartment syndrome of the foot represents a clinical scenario in which prompt recognition and treatment are necessary. Diagnosis can be challenging, as symptoms often are not as distinct as the classic findings in other anatomic locations (leg or forearm). Tense swelling and pain out of proportion to injury may be the most reliable signs. Releasing a circumferential dressing and elevating the foot assist with decreasing intracompartmental pressures. No high-level evidence exists confirming the benefit of fasciotomies; however, consensus seems to favor the practice of urgent surgical intervention. Late manifestations typically involve forefoot deformity. Surgical correction may be warranted.

Проблемы диагностики и хирургического лечения вальгусного отклонения первого пальца стопы (обзор литературы)

Treatment of valgus deformity of the first toe is today one of the intensively developing areas of modern orthopedics. The complexity of treatment of this pathology is predetermined, first of all, by its multicomponent nature. Forefoot deformities are often the main cause of a decreased quality of life, which makes the patient irritable, inactive, and also makes it impossible to use standard footwear, and sometimes even orthopedic one. The purpose of our study was the analysis of scientific literature devoted to the problems of diagnosis and surgical treatment of valgus deviation of the 1st toe (hallux valgus). The materials of the study were domestic and foreign articles, reviews and monographs on the surgical treatment of hallux valgus, with mandatory analysis of long-term treatment outcomes. The history of the development of treatment of this pathology is presented with the analysis of surgical treatment methods aimed at different links of pathogenesis, as well as complications arising from the use of different techniques. The article presents modern trends in development and ways to improve the methods of surgical treatment of valgus deviation of the first toe. The analysis of the literature data showed significant success in the surgical treatment of valgus deviation of the first toe. However the current percentage of relapses may be due to the lack of an accurate method for determining proximal articular set angle (PASA) in the preoperative period, as well as the lack of the hallux valgus treatment able to eliminate valgus deviation of the first toe and avoid recurrence of the disease due to a more accurate correction of PASA.

Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton's Neuroma.

Morton's neuroma is one of the common causes of forefoot pain. In the present study, hyaluronic acid injection was performed on patients to determine the efficacy and adverse effects of hyaluronic acid in management of Morton's neuroma. Eighty-three patients with Morton's neuroma in their third intermetatarsal space with definite Mulder's click were included in the study. Those with severe forefoot deformities such as forefoot cavus or hallux valgus on plain X-rays were excluded. Ultrasound-guided hyaluronic acid injections were performed on all patients weekly for 3 weeks. Pain during walking using visual analogue scale (VAS) and AOFAS Forefoot Scale were prospectively evaluated preinjection, and at 2, 4, 6, 12 months postinjection. Significant improvement in VAS and AOFAS Forefoot Scale were seen overall at 2 months after hyaluronic acid injections ( P < .05). Then, there were almost no changes after 4 months, continuing until 12 months. The mean VAS was decreased from 73.1 initially to 23.0 at 12 months and AOFAS Forefoot Scale was increased from 32.2 to 86.5. There were no complications which occurred. In the present study, ultrasound-guided hyaluronic injection was clinically effective for pain relief and functional improvement for at least 12 months in patients with Morton's neuroma. However, numbness associated with Morton's neuroma should be addressed more cautiously since it may persist without much improvement. Level IV, retrospective case series.

Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features

BackgroundThe purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes. MethodsWe conducted a cross sectional study including 60 patients with spondyloarthritis over a period of six months. Anamnesis, clinical examination, podoscopic examination, biological tests and X-rays of feet were done for each patient. ResultsFoot involvement was found in 31 patients (52%). It was symptomatic in 35% of cases and inaugural in 42% of cases. The most frequent site was the hindfoot (22 patients/31). Radiological findings were: erosion (17%), reconstruction (33%), erosion and reconstruction (50%). Forefoot involvement was found in 18/31 patients. Forefoot deformities were found in 9 patients. Two patients had sausage toe and feet skin abnormalities were observed in 12 patients. At podoscopic examination, 23 patients had abnormal footprints. Foot involvement was more frequent in peripheral spondyloarthritis (p=0.008). Patients with foot involvement had an advanced age of disease onset (p=0.05), a shorter disease duration (p=0.038) and more comorbidities (p=0.039). Foot involvement was correlated with C Reactive protein (p=0.043). ConclusionIn our study, foot involvement and foot symptoms were seen frequently in spondyloarthritis and it is associated with late onset of the disease and with higher inflammation in blood tests.

Correction of Residual Metatarsus Adductus Deformity Following Ponseti Management of Idiopathic Clubfoot in Toddlers by Tibialis Anterior Tendon Transfer

Background: Ponseti technique becomes a gold standard treatment for correction of idiopathic clubfoot and widely reports to provide reliable results. However, a relapsed deformity may occur owing to imbalance of strong tibialis anterior and weak its antagonist resulting in dynamic metatarsus adductus deformity of forefoot. Purpose of study: The aim of this study is reporting the results of our experience regarding tibialis anterior tendon transfer for correction of previous deformity. Patients and methods: In this prospective case series study, 21 children (9 females) with residual dynamic metatarsus adductus following treatment of idiopathic congenital talipes equinovarus utilizing Ponseti technique in the orthopedic department of Al-Azher University Hospital, Mapera Zagazig Hospital and El-Bakry General Hospital treated by transfer of tibialis anterior tendon into third cuneiform bone. Evaluation comprised clinical, appearance, radiological assesment and complications. Results: Mean follow-up 23.4 months and mean age of patients 35.3 months. All transferred tendons healed properly without major complications. Clinically; Dimeglio score improved from 5.8 preoperative to 1.3 postoperative and the clinical appearance according to Garceau and Palmer improved from 2.8 to 3.4. No major complications or correction loss developed in any case. Conclusion: Residual dynamic metatarsus adductus deformity following Ponseti management of congenital talipes equinovarus can be corrected efficiently and simply by tibialis anterior tendon transfer.

A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities.

IntroductionHallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes.MethodsThis case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA).ResultsThe patients’ mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications.ConclusionDistal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies.

Incidence of thyroid disease in patients with forefoot deformity

Chitin, a natural biopolymer with numerous commercial applications, is found in Australian Rock lobster shells at approximately 25% on a dry basis. Mineral removal for chitin production from crustacean shells has conventionally been carried out with corrosive inorganic acids but in addition to negative potential environmental effects the technique generates detrimental impacts on the physiochemical properties of chitin. Demineralization of crustacean shells using organic acids intensified by microwave is another promising alternative. Although the process has been shown to demineralize shrimp shells with very low mineral residue, the use of a large chemical ratio and high temperature due to a lack of optimization could be major limitations for its industrial application. Moreover, the use of this process for difficult demineralization crustaceans as Rock lobster shells has not yet been investigated. In this study, deproteinized Rock lobster shells were demineralized using a food-grade lactic acid intensified by microwave. This process was optimized using a Box-Behnken design for three key process parameters including lactic acid/shells (LA/S) ratio, time, and temperature. Demineralization degrees achieved from the process were used for setting up a mathematical relationship and drawing plots. Analysis results revealed the LA/S ratio was the most influential factor and the optimized process with high demineralization degrees was achieved at a mild condition (LA/S ratio of 18 mL/g, 23 min). Besides its chemical structure being similar to that of commercially available chitin, lobster chitin obtained from the optimized process had low residues of minerals (0.99%) and protein (1.6%) which could be used for advanced applications. Moreover, composition of minerals recovered from the optimized process contained 87% of calcium potentially providing another value-added product, calcium lactate. All these significant results indicate the microwave-intensified lactic acid demineralization (MILAD) could be used for efficient production of high quality lobster chitin in an environmentally-friendly and sustainable manner.

Long-term outcomes of surgical correction of severe forefoot deformities

Long-term outcomes of surgical correction of severe forefoot deformities

Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial

BackgroundDespite impressive results of the pharmacological management of rheumatoid arthritis, still certain patients suffer from rheumatoid forefoot problems. Surgical treatment of these forefoot deformities can be an option. In literature no high-quality studies on this topic can be found.The goal of present study is to compare the results of a metatarsal head (MTH) resecting technique with a MTH preserving technique in the operative treatment of severe rheumatoid forefoot deformity. MethodsPatients suffering from well-defined rheumatoid forefoot deformity were prospectively enrolled in three institutions. This non-blinded study had a randomised clinical design and eligible patients were randomly assigned to undergo either resection of preservation of the MTH. The primary outcome measure consisted of the AOFAS score. Secondary outcome measures were: the FFI, the VAS for pain and the SF-36. ResultsTwenty-three patients (10 in MTH preservation group) were included and analysed. After one year follow-up no significant differences in AOFAS score and additional outcome factors were found. A total of 10 complications in 23 patients were reported. ConclusionsThis randomised clinical study did not show significant clinical difference between a MTH resecting and a preserving procedure in patients suffering from rheumatoid forefoot deformity. Both procedures resulted in considerable improvement of pain and activity scores.

Plantar pressure and surgical indication of toe arthroplasty for rheumatoid forefoot deformity

Objectives: The objective of this study is to clarify the surgical indication for rheumatoid forefoot deformity according to background characteristics and plantar pressure.Methods: Patients with rheumatoid arthritis were divided into a non-surgical group (group N) and a surgical group (group S). The former consisted of 225 ft, and the latter consisted of 88 ft. DAS28, Japanese Society for Surgery of the Foot rheumatoid arthritis foot and ankle scale (JSSF scale) and hallux valgus angle (HVA) were evaluated as background characteristics. Distribution of peak pressure as plantar pressure was measured in nine sections.Results: In groups N and S, the mean DAS28 was 3.6 and 3.0, the mean JSSF scale was 81.1 and 63.0, and the mean HVA was 19.9° and 35.3°, respectively. The mean peak pressure of group S at the first and third metatarsophalangeal joints was significantly higher compared with group N. Significant differences between the two groups were also seen in Δ pressure (the difference between the maximum and minimum peak pressure values). The cut-off values were 75.0 for JSSF scale, 24.9° for HVA and 3.94 kg/cm2 for Δ pressure.Conclusions: The combined assessment of HVA and Δ pressure was found to be useful as an indication for surgical treatment of the forefoot.

Outcomes of modified metatarsal shortening offset osteotomy for forefoot deformity in patients with rheumatoid arthritis: Short to mid-term follow-up

Objectives: Advances in drug therapy for rheumatoid arthritis (RA) have been encouraging us to preserve the metatarsopharangeal (MTP) joint in correction of forefoot deformities, and original metatarsal shortening offset osteotomy was recommended as one of the conventional surgical options for forefoot deformities in RA cases. The objective of this study was to evaluate short- to mid-term outcomes of modified metatarsal shortening offset osteotomy.Methods: A retrospective observational study was completed for 80 RA cases (mean follow-up period: 3.2 years) who underwent modified metatarsal shortening offset osteotomy. Both lesser toe scales and RA foot ankle scales were administered using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a postoperative self-administered foot evaluation questionnaire (SAFE-Q) at final follow-up was also checked to evaluate clinical outcomes.Results: This procedure significantly improved clinical scores of both the JSSF [lesser toes and RA foot and ankle] scales. Of 80 feet, 24 (30%) showed recurrence of MTP joint subluxation/dislocation. Furthermore, the feet in the recurrence group showed significant varus hindfoot. On the other hand, valgus foot in the recurrence group more frequently included midfoot bony ankyloses. All of the affected feet showed the limitation of MTP joints (<70°) after surgery.Conclusions: Modified metatarsal shortening offset osteotomy was recommended for RA forefoot disorders as one of the joint preservation surgeries in short- to mid-term follow-up. However, some modifications to avoid limitation of ROM in the MTP joint are required. It must be borne in mind that varus hindfoot and/or bony ankyloses in the mid-hindfoot can cause recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint.

Fusion of the First Metatarsophalangeal Joint and Second to Fifth Metatarsal Head Resection for Rheumatoid Forefoot Deformity

The goals of the present study were to evaluate the mid-term results of first metatarsophalangeal joint fusion combined with second to fifth metatarsal head resection in rheumatoid forefoot deformity and identify the prognostic factors. The inclusion criteria were 2010 American College of Rheumatology and/or European League Against Rheumatism criteria for rheumatoid arthritis; symptomatic forefoot deformity; first metatarsophalangeal joint fusion and second to fifth metatarsal head resection; and a minimum of 4 years of follow-up data available. The patients were evaluated using the Disease Activity Score 28 for rheumatoid arthritis, Health Assessment Questionnaire for Rheumatoid Arthritis, Foot Function Index, forefoot American Orthopaedic Foot and Ankle Society scale, and weightbearing radiographs. Different pre-, intra-, and postoperative variables were investigated to identify the prognostic factors. Sixty-two patients (89 feet) with a mean age of 60.8°± 9.4 years and 85.5°± 22.4 months of follow-up data were included. The preoperative American Orthopaedic Foot and Ankle Society scale score was 33.4 ± 16 points and improved significantly (p < .001) after surgery (mean 82.9 ± 11.7 points). The mean Foot Function Index improved significantly (p < .001) from 131.6 ± 37.4 to 77.4 ± 46.3 points at the last follow-up visit. Only the revision surgery variable was significantly (p = .02) related to poor outcomes. Revision was necessary in 8 feet (9%). This procedure produced satisfactory results. Poor outcomes were significantly related to the necessity for revision surgery for nonunion, malunion, inadequate metatarsal resection, and painful hardware.

The Accuracy and Reliability of Plantar Pressure Measurements for the Early Diagnosis of Foot Deformities in Patients Suffering from Rheumatoid Arthritis

Aim: Pedobarographic analysis may be employed to quantify foot function, however, the value of pedobarographic analysis as a diagnostic tool for the screening of recently diagnosed Rheumatoid Arthritis (RA) patients remains uncertain. The aim of this systematic review was to: a) assess the different instruments used to analyse plantar pressure; b) to report on the technical considerations associated with manual and automatic masking and c) to assess the validity together with the inter- and intraobserver reliability of pedobarographic analyses for identification of pathological profiles in patients suffering with RA. Method: Following the PRISMA guidelines, a literature search was undertaken using a variety of computerised bibliographic databases. The Quality Appraisal of Diagnostic Reliability was employed to assist in the analysis of reliability. Results: A review and analysis of the literature found only 20 papers with relevant reliability and accuracy. Conclusion: The literature concerning the validity and reliability of pedobarography in the screening for early onset foot deformities in RA patients has not been proven. Although the forefoot has been identified as a common area of the plantar surface where deformities occur in RA, there are very few studies that demonstrate any subtle changes that could forecast forefoot deformities in asymptomatic RA patients.

Treatment of hallux valgus

The reasons for hallux valgus are hard to define. It is a multifactorial forefoot deformity with a complex pathogenesis, which most commonly affects women aged forty to sixty. It is characterised by anatomic deformities associated with mild to severe cutaneous alterations. Radiographic examinations are fundamental in the diagnosis, as they allow surgeons to select the surgical strategic plan after clinical assessment of the intermetatarsal angle, the metatarsophalangeal, the PASA and DASA. The main purposes of surgery are to decrease severe pain and inflammation and correct deformity. Through the years, a wide variety of operations and treatment techniques have been developed and adapted according to individual cases. We can classify minimally invasive hallux valgus corrective techniques into three main groups: percutaneous techniques (MIFS), percutaneous techniques with internal fixations, and minimally invasive techniques with temporary fixations like Kirschner wires (SERI or PDO).

Le complicanze della chirurgia mini-invasiva dell’avampiede

There is increasing interest in and use of minimally invasive foot surgery (MIFS), as it involves short operating time, quicker recovery, reduced hospital stays, better cosmetic results and fewer complications compared to open surgery. However, limited evidence is available in relation to complications associated with MIS for forefoot deformity correction. Available publications lack of homogeneity in terms of case series, patient selection and clinical indicators, mostly being retrospective observational studies with insufficient randomised control trials. The aim of this study was to report the complications following MIFS. In this evaluation, as the Author conceived it as a feasible tool of current clinical practice, complications can be broadly divided into three categories: (1) those related to the learning curve; (2) typical postoperative clinical conditions, such as oedema and haematoma; and (3) true complications. MIFS procedures are safely performed in a range of clinical settings, on varying degrees of digital deformity, resulting in an overall low complication rate compared to conventional open surgery. Long-term safety and efficacy of these techniques need further scientific validations as well as future treatment algorithms to guide clinical decision making.

Classical Mitchell's osteotomy in the management of symptomatic hallux vulgus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Forty adult patients (56 feet) with symptomatic hallux vulgus, who did not respond to conservative treatment, were managed with Mitchell’s osteotomy.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 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&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;