Mitchell's osteotomy using internal fixation and early mobilisation

Abstract

We present the results of a prospective trial of osteotomy of the metatarsal neck for hallux valgus in 31 feet of 23 women, using a new stapling device with no plaster splintage and early weight-bearing. Surgery was performed for pain (29 feet) and difficulty with footwear (nine feet). The average time for return to light work was 3.3 weeks, and to full work 8.3 weeks after operation. Seventeen patients had full recovery within three months and 21 of the 23 patients had complete relief of pain. Shoes were more comfortable in 17 feet and 9 patients could wear narrower shoes. Only two patients were unsatisfied with the appearance of the foot. All the osteotomies united, and the average hallux valgus angle was improved on radiographs from 35 degrees to 23 degrees. The mean first metatarsal angle was reduced from 16 degrees to 11 degrees. The new technique allows more accurate surgery and easier postoperative management.

Tratamiento quirúrgico percutáneo del hallux valgus mediante osteotomías múltiples

“…En nuestra práctica solamente la aplicaremos, como defiende Schnepp 32 , cuando comprobemos que una osteotomía distal no nos ha dado la corrección necesaria del mismo, y por tanto realizamos la osteotomía bipolar (distal y proximal) que haremos por técnicas percutáneas 33 obteniendo resultados muy satisfactorios. La corrección obtenida sobre el ángulo metatarsofalángico con la práctica de osteotomías distales del primer metatarsiano es limitada, aproximadamente entre 10 a 25°según las series 34,35 ; por esta razón, diversos autores 6,25,[36][37][38] recomiendan asociar la liberación de la cápsula lateral y desinserción del abductor a nivel de la falange, con lo que se consiguen correcciones muy superiores a los 25°.…”

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

“…We encountered few complications in our study. 2,16,19 Four of our patients had infection in postoperative period. Three subsided with i/v antibiotics one needed removal of sutures and wound debridement.…”

“…Briggs et al had 84% fully satisfied and 10% satisfied with some reservations as far as pain over 1 st MTP joint is concerned while 75% were fully satisfied and 19% were satisfied with reservations as far as appearance is concerned. 16 Glynn had 92% excellent or good results in his series. The average vulgus angle in our series improved from 35 degree to 17 degree and IM angle from 17 to 9 degree.…”

“…A number of modifications have been used by others like fixation of osteotomy by Herbert's screw (Wu's bunienectomy) or specially designed stapples (Briggs et al). 15,16 The reported advantages of implant fixation is that they increase strength and stability at osteotomy site thus allowing early weight bearing and increased ROM at MTP joint.…”

“…18 The only advantage seems to be early return to work as in Briggs study, who fixed the osteotomy by special staples, it took on an average 8.3 weeks for return to full employment as compared to 15.5 weeks in our study. 16 Further use of suture obviates the need for re surgery to remove the implant and other hardware related problems. The major indication for surgery in our series was pain over bunion not responding to conservative treatment of at least six months duration.…”