Mitchell Osteotomy Research Articles

Recurrence Rates With Longer-Term Follow-up After Hallux Valgus Surgical Treatment With Distal Metatarsal Osteotomies: A Systematic Review and Meta-analysis.

Recurrence of hallux valgus (HV) following corrective surgery is a frequent concern. A recent systematic review estimated recurrence of HV in only 4.9%, which may be an underestimation, as most included studies had short- to mid-term follow-up. The purpose of this systematic review and meta-analysis was to assess long-term outcomes of distal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis, and to assess HV recurrence rates reported in studies that had a minimum follow-up of 5 years. This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of distal osteotomies of the M1 for noninflammatory and nondegenerative HV at a minimum follow-up of 5 years. We found 17 eligible studies comprising 18 data sets, reporting outcomes of 4 categories of osteotomies: Chevron, Mitchell, Bösch, and "others." The HV recurrence rate was 64% considering the threshold of >15 degrees hallux valgus angle (HVA), 10% having >20 degrees, and 5% having >25 degrees. At a minimum of 5 years following distal osteotomies of the M1, the mean weighted postoperative HVA was significantly higher for Mitchell osteotomies compared with the 3 other osteotomies reviewed. There were otherwise no significant differences in recurrence rates using the 3 HVA thresholds, or intermetatarsal angle among any of the surgical techniques reported in 2 or more studies. The pooled HV recurrence rates considering the various thresholds of HVA were as follows: 64% having >15 degrees, 10% having >20 degrees, and 5% having >25 degrees. The recurrence rates in the long term for all categories of surgical procedures suggest that better understanding of pathogenesis and prognosis of HV is required before modifying or introducing new surgical techniques. Level IV, meta-analysis.

Comparison of modified Mitchell and Chevron osteotomies for hallux valgus

BackgroundGood clinical and radiological outcomes in mild-moderate hallux valgus (HV) can be achieved with Chevron osteotomy (CO) and modified-Mitchell osteotomy (MMO). The main goal of the present study was to compare the clinical and radiological outcomes after CO and MMO in HV. MethodsThe study included 45 patients, comprising 40 females with a mean follow-up of 87.5 ± 27.8 months. The outcome measurements of metatarsal length (MT1), HV angle (HVA), intermetatarsal angle (IMA), clinical outcomes, and metatarsalgia were evaluated pre- and postoperatively. ResultsNo significant difference was determined between the MMO and CO groups in respect of metatarsalgia and AOFAS scores. The CO resulted in a significantly larger decrease in the MT1. The mean HVA and IMA correction was significantly greater after MMO than after CO. ConclusionSince MMO may prevent MT1 shortening, which is a typical problem in the Mitchell osteotomy, MMO may be preferred over CO in patients with preoperative shortened first metatarsal.

Clinical and radiological outcomes of modified Mitchell's osteotomy using three-point fixation for hallux valgus.

This study examined the clinical and radiographic outcomes of modified Mitchell's osteotomy using three-point fixation with a full-thread headless screw. This technique was described to resolve the problem of excessive shortening and overshifting of the metatarsal. A total of 33 feet of 26 patients underwent modified Mitchell's osteotomy with three-point fixation for hallux valgus. Clinical and radiographic outcomes were assessed preoperatively and at specific time points of follow-up by using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, hallux valgus angle (HVA), and intermetatarsal angle (IMA). The global AOFAS scale score (0-100) significantly improved from 50.7 ± 9.9 preoperatively to 84.4 ± 8.7 at the final follow-up. The HVA significantly improved from 30.2 [Formula: see text]± 6.0 [Formula: see text] to 9.0 [Formula: see text] ± 5.0 [Formula: see text], and the IMA significantly improved from 14.2 [Formula: see text] ± 2.6 [Formula: see text] to 5.1 [Formula: see text] ± 2.0 [Formula: see text]. None of the patients experienced nonunion and transfer metatarsalgia. Complications were observed in two feet, and one foot had recurrence of hallux valgus. Modified Mitchell's osteotomy using three-point fixation with a full-thread headless screw is a reliable alternative treatment for hallux valgus, even in patients with severe deformities.

Temporary Kirschner wire fixation of the first metatarsophalangeal joint before osteotomy for hallux valgus

IntroductionNumerous operative procedures have been described for correction of hallux valgus, including distal step-cut osteotomy such as the Mitchell osteotomy. However, overcorrection can occur due to technical problems with the initial metatarsal osteotomy. Here, we describe a modified Mitchell osteotomy with a novel method, the temporary Kirschner wire fixation of the first metatarsophalangeal joint (TeKFiM) method (Tonogai method), that can be used before osteotomy for hallux valgus to avoid incongruency and overcorrection. Operative techniqueA skin incision and Y-shaped capsulotomy are performed and the medial exostosis is excised. Lateral capsule release is done if the first metatarsophalangeal (MTP) joint cannot be reduced manually. Next, a Kirschner wire (K-wire) is inserted subcutaneously through the medial side of the first proximal phalanx to the lateral side of the first metatarsal to preserve the correct congruency of the first MTP joint during surgery. To correct pronation of the distal fragment, step-off transverse cuts are made in the distal fragment, as described by Mitchell, reaching one-second to two-thirds of the transverse diameter of the neck from the plantar medial side. After the osteotomies are completed, the lateral spike of the proximal fragment is flattened. The distal fragment is displaced laterally and slightly plantarward, and the pronation deformity of the distal fragment is corrected by inserting a K-wire to act as a joystick. The osteotomy site is stabilized using two Herbert-type screws. After removal of the K-wire, the operation is completed by closing the medial capsule of the first MTP joint and the skin. A plantar cast is applied for 2 weeks, followed by a special heel brace for 4–6 weeks. Sutures are removed 2 weeks after surgery. Patients are allowed to start weightbearing gradually as tolerated from 2 weeks after surgery. DiscussionAfter osteotomy, it is difficult to maintain the correct congruency of the first MTP joint due to instability of the distal fragment. The TeKFiM method (Tonogai method) reliably maintains this congruency during surgery. Also, by using a K-wire as a joystick to fix the joint in correct congruency, the first toe is rotated and pronation is corrected by supinating the distal fragment. The K-wire also serves as a landmark for determining how far the distal fragment is shifted plantarward. ConclusionsWe have developed a modified Mitchell osteotomy with the novel TeKFiM method (Tonogai method) before osteotomy for hallux valgus to avoid incongruency and overcorrection. This method also provides a landmark to correct pronation and plantarward shifting.

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

IntroductionThe 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. MethodsBetween 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. ResultsOf 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. ConclusionShort- 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.

A comparative study of modified Mitchell's and scarf osteotomies for moderate hallux valgus

A comparative study of modified Mitchell's and scarf osteotomies for moderate hallux valgus

The results of hallux valgus treated by modified Mitchell osteotomy with one screw fixation

The results of hallux valgus treated by modified Mitchell osteotomy with one screw fixation

Mitchell osteotomy for moderate to severe hallux valgus deformity

Mitchell osteotomy for moderate to severe hallux valgus deformity

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;

Modified Mitchell Osteotomy Alone Did Not Have Higher Rate Of Residual Metatarsalgia Than Combined First And Lesser Metatarsal Osteotomy

Category: Bunion Introduction/Purpose: Transfer metatarsalgia (TM) is a common forefoot disorder secondary to hallux valgus (HV), and the best treatment for HV related TM remains controversy. Some authors suggested a combined lesser metarsal osteotomy while undergoing HV surgery, but some authors didn’t agree with it and concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of the retrospective study was to compare clinical outcomes in the patients with and without combined lesser metatarsal osteotomy while they received HV correction surgery. Methods: We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All the patients underwent HV correction with Modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) score and residual metatarsalgia were assessed, and hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsal shortening, and plantar shifting of metatarsal head were measured. Results: Sixty-five patients ( 83 feet ) meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were grouped as combined surgery group, and the others were grouped as control group ( 53 feet ). The overall rate of persistent symptomatic metatarsalgia was 19.28 % after operative treatment. There were 6 feet with residual metatarsalgia in combined surgery group, and 10 feet in control group. There was no significant difference in the rate of persistent symptoms between groups ( p=0.9). Conclusion: According to this result, modified Mitchell osteotomy alone didn’t have higher rate of residual metatarsalgia than combined surgery. Besides, we also found that the average recovery rate of transfer metatarsalgia was about 80.7% and the patients, whose preoperative hallux valgus angle was more than 30 degrees, had the higher risk of residual metatarsalgia after surgery.

Modified Mitchell osteotomy alone does not have higher rate of residual metatarsalgia than combined first and lesser metatarsal osteotomy

Transfer metatarsalgia (TM) is a common forefoot disorder secondary to hallux valgus (HV). Some authors suggest that a combined lesser metatarsal osteotomy while undergoing HV surgery improves metatarsalgia, whereas others concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of this retrospective study was to compare clinical outcomes in patients with and without combined lesser metatarsal osteotomy while receiving HV correction surgery. We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All patients underwent HV correction with modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society score and residual metatarsalgia were assessed, and radiographic measurements were carried out. Sixty-five patients (83 feet) meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were classified as the combined surgery (CS) group, and the others were classified as the control (CN) group (53 feet). The overall rate of persistent symptomatic metatarsalgia was 19.28% after operative treatment. There were six feet with residual metatarsalgia in the CS group, and 10 feet in the CN group. There was no significant difference in the rate of persistent symptoms between the two groups (p = 0.9). According to this result, modified Mitchell osteotomy alone did not have a higher rate of residual metatarsalgia than CS. We also found that the average recovery rate of TM was about 80.7% and those patients whose preoperative HV angle was > 30° had the higher risk of residual metatarsalgia after surgery.

Outcome of a Modified Mitchell Osteotomy for Severe Hallux Valgus Deformity

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.

Chevron Versus Mitchell Osteotomy in Hallux Valgus Surgery: A Comparative Study

Good clinical results have been reported for chevron and Mitchell osteotomies in mild hallux valgus (HV). The primary aim of the present study was to compare first metatarsal shortening after chevron and Mitchell osteotomies in HV. The secondary outcome measures were the degree of valgus correction, metatarsalgia, and patient satisfaction. A total of 84 patients were included in the present study and were treated from 2005 to 2007; 42 patients were in each group. The outcome measurements—first metatarsal length, HV angle, 1-2 intermetatarsal angle, satisfaction, and metatarsalgia—were taken preoperatively and at follow-up. The Mitchell osteotomy resulted in a significantly larger decrease in the first metatarsal length. No significant difference in transfer metatarsalgia was found. Approximately 30% of patients were mildly or not satisfied after HV surgery. Mitchell osteotomy leads to a larger decrease in the first metatarsal length. Patients with metatarsalgia performed poorly, and no significant differences in metatarsalgia were found. Preventing postoperative metatarsalgia is important for a successful outcome after HV surgery.

Hallux Valgus in Males—Part 2

In an early report on this patient cohort, we concluded that a hallux valgus deformity in males is frequently hereditary in nature. An increase in the distal metatarsal articular angle (DMAA) was observed to be the major defining characteristic of hallux valgus in males. In this follow-up study, our goal was to evaluate the effectiveness of surgical treatment for this cohort of male patients. Data from 50 feet of male patients with hallux valgus who were surgically treated by the same surgeon between 1985 and 2005 were retrospectively analyzed. The technique was algorithmically chosen according to the severity and complexity of the deformity. Thus, 10 chevron osteotomies, 9 biplanar chevron osteotomies, 12 Mitchell osteotomies, 9 scarf osteotomies, and 10 basilar first metatarsal osteotomies were performed. The average follow-up was 10 years (range, 2-20). After analyzing the angular radiological parameters, sesamoid subluxation, and the articular congruency, most procedures proved to have achieved adequate correction of the angular deformities. When examining each of the procedures separately, 4 of the 5 procedures had similar corrective capacities; the scarf osteotomy however had decidedly inferior results. The improvement in the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score demonstrated the clinical and functional improvement. The algorithm was based mainly upon the presence of increased DMAA and increased severity of angular deformities. We conclude that hallux valgus deformities in males were adequately corrected with the selected techniques. Greater difficulty or resistance to surgical treatment could not be detected when we contrasted our results to females. The scarf osteotomy proved to have an inferior corrective capacity compared to the other techniques used in this series. Level III, retrospective comparative series.

Modified Mitchell Osteotomy with Screw Fixation for Correction of Hallux Valgus

The authors have performed more than 1500 cases of a Mitchell osteotomy and traditionally used two crossed pins for fixation. The previous series showed some complications related to pin tract infection, pin migration, and transfer metatarsalgia. Since 2009, the authors have used a compression screw for fixation and made some technical modifications and the results are reported in this article. A total of 95 patients underwent a Mitchell ostotomy to correct hallux valgus deformity with fixation with multi-use compression (MUC) screws. Hallux valgus angle (HVA), intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale were measured preoperatively and postoperatively. ~There were statistically differences between the preoperatively and postoperatively HVA, first IMA, and AOFAS hallux metatarsophalangeal-interphalangeal scores. Five patients (8/137 feet, 5.8%) underwent removal of the screw because of screw tip irritation. Eight patients (9/137 feet, 6.5%) had transfer metatarsalgia of the second metatarsal, with two of them caused by dorsal tilt of the metatarsal head. One patient (1/137 feet, 0.7%) had undercorrection. There was no superficial infection, deep infection, nonunion, or osteonecrosis of the first metatarsal head. On the basis of the results observed in this study, it appears that the use of a multi-use compression screw provides satisfactory stabilization of the modified Mitchell osteotomy and was not associated with any serious complications. The modified technique also helped reduce transfer metatarsalgia.

Mitchell's osteotomy in the management of hallux valgus: An Indian perspective

Background:Hallux valgus is a common condition that affects the forefoot. A large number of procedures are described for managing this condition. Mitchell's osteotomy and its modifications are being widely used for treating hallux valgus. However, most of the studies describe the results from the developed world. We present results of the classic Mitchell's osteotomy in hallux valgus in Indian subcontinent.Materials and Methods:Forty eight adult patients (including 12 bilateral ones) in the age range of 18–60 years with hallux valgus were managed with the classic Mitchell's osteotomy. Pain over the bunion was the reason for surgery in 53 of 60 feet and cosmesis in the remaining 7 feet. Patients with hallux valgus angle more than 20° and not responding to a trial of conservative treatment were included. Patients having metatarsophalangeal (MTP) joint osteoarthritis (Grade II and higher), hallux rigidus, rheumatoid arthritis, and with subluxation of MTP joint were excluded from the study. Further, patients with first metatarsal more than 3 mm shorter than second metatarsal were also excluded.Results:The average follow-up period is 3 yrs (range 18months – 6yrs). About 55 feet (83%) were painless after surgery. Forty-two (70%) patients were happy with the cosmetic results of the surgery. Metatarsalgia was the reason for dissatisfaction with the procedure in five patients. The average correction of hallux valgus and the intermetatarsal angles achieved was 19.7° and 6.9°, respectively. Using the Broughton and Winson scoring system, 37 (61.7%) feet had excellent results, 18 (30%) had good, and five (8.3%) feet had a poor results.Conclusion:The classic Mitchell's procedure is a simple procedure and gives good cosmetic and radiological results.

Long-term Results of Mitchell's Procedure for Hallux Valgus Deformity: A 5- to 20-year Followup in 204 Cases

There are limited studies on the long term outcome of Mitchell's osteotomy for hallux valgus deformity. We present the long term results of 204 cases. Postoperative clinical and radiological evaluation with a mean follow up of 12.9 years was performed on patients with preoperative hallux valgus angles (HVA) of up to 50 degrees and intermetatarsal angles (IMA) of up to 20 degrees. Two crossed Kirschner wires were used to fix the capital fragment; lateral soft tissue release performed when deemed necessary. Comparisons were made between the pre- and postoperative measurements using a Mann-Whitney U-test. Statistical significance was defined at p < 0.05. The mean AOFAS score improved from 49.6 to 87.9 points (p = 0.004). There was significant improvement in the HVA and IMA, 33.8 degrees versus 16.1 degrees (p = 0.002) and 15.2 degrees versus 8.2 degrees (p = 0.004), respectively. Fifty-seven cases (27.9%) had preoperative HVA greater than 40 degrees but only 16 required lateral soft tissue release with no significant difference in the postoperative HVA (21.3 versus 20.8, p = 0.08). There was a significant change in lateral metatarsalgia and symptomatic callosities (18.3% versus 11.8%, p = 0.023). In 97.6% of cases the patients were satisfied with the overall result. Revision surgery was performed in five cases (2.5%). Mitchell's osteotomy was a reliable technique with successful outcome and low complication rate when performed with Kirschner wire fixation and lateral soft tissue release when appropriate. It may also be successfully performed with hallux valgus angles greater than 40 degrees.

Fixation of Mitchell’s osteotomy with bioabsorbable pins for treatment of hallux valgus deformity

We hypothesised that the use of bioabsorbable pins in Mitchell's osteotomy would improve the outcome of patients treated for hallux valgus deformity. A total of 68 patients underwent Mitchell's osteotomy to correct hallux valgus deformity: 33 patients (group A) underwent Mitchell's osteotomy augmented with bioabsorbable pins and 35 patients were treated with the classic operative procedure (group B). Hallux valgus angle (HVA), intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the visual analogue score (VAS) for pain were measured preoperatively and postoperatively. There was no statistically significant difference between the two groups as far as the improvement of the IMA, HVA and AOFAS scale were concerned. Patients of group A had significantly less postoperative pain and returned to their previous activities earlier than patients of group B. The use of the pins did not improve the final outcome of the osteotomy. However, it allowed for faster rehabilitation due to less postoperative pain.

Three-Dimensional Analysis of Different First Metatarsal Osteotomies in a Hallux Valgus Model

This study evaluates and compares three-dimensional (3-D) changes in geometry of the first metatarsal (MT1) independent of soft tissue corrections of 5 common osteotomies: three distal (Chevron, Mitchell, and Wilson), one proximal (Stephens basal), and one combined proximal/distal (Scarf), using standardized synthetic bone models. A digitizing system was used to measure and record points on the synthetic bone models in 3-D space. Computer vector analysis calculated 3-D rotations and translations of the MT1 head plus the conventional intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). The Wilson and Mitchell's osteotomies produced significant shortening (p < 0.001) in contrast to the three other osteotomies. All the osteotomies produced a reduction in the 3-D IMA. The Scarf and Stephens basal osteotomies reduced the DMAA. All of the osteotomies resulted in lateral translations and depression of the MT1 head. While there were no significant (p > 0.05) translational differences between the Scarf and Stephens basal osteotomies, there were rotational differences, with the Stephens basal producing significantly more plantar flexion (p = 0.000) and pronation (p < 0.001) than the Scarf. This geometric study indicated many of the MT1 head changes following metatarsal osteotomy to be out-of-plane translational and multiplanar rotations which cannot be determined using AP radiographs alone. We advocate judicious choice of osteotomy to achieve the desired correction of hallux valgus in each individual.

Sesamoid bone complex and hallux valgus deformity. A retrospective analysis of 82 Mitchell osteotomies

The aim of the operative treatment of the hallux valgus deformity is to correct the medial luxation of the first metatarsal head out of the sesamoid complex, the restoration of a congruent joint, the patient after treatment should be painfree. 82 patients were available for an independent clinical and radiological review. The median follow up was 32 months. The evaluation of the results are based on objective and subjective assessment of the patients as well as on radiographic criteria, such as hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal bone, subluxation, lateral positioning of the osteotomized MT I-head and position of the sesamoid complex. Depending on the degree of "lateralisation" of the sesamoid complex seven groups were defined: 0/0, 1/0, 1/1, 2/1, 2/2. 2/3, 3/3 following Appel. Following objective criteria 61% of the patients were evaluated excellent or good, following subjective criteria 77% were evaluated excellent or good. Isolated parallel shifting seems to be sufficient in mild forms of hallux valgus (sesamoid complex group 2/2 or less), while the severe subluxation in the metatarsophalangeal joint (sesamoid complex group 2/3, 3/3) requires an additional lateral wedge osteotomy.