Modified Mitchell Osteotomy for Hallux Valgus

Kuo, Chung-Hung; Huang, Peng‐Ju; Cheng, Yuh-Min; Huang, Kuan-Yu; Chen, Tai-Bin; Chen, Ying-Wang; Lin, Sen-Yuen

doi:10.1177/107110079801900903

Cited by 45 publications

(26 citation statements)

References 19 publications

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“…Good correction of the deformity has been reported. 33,34 Nevertheless, shortening of the first metatarsal occurs due to removal of bone to create the stepcut. This, combined with a lack of inherent stability resulting in dorsal malunion, has led to reports of transfer metatarsalgia in between 10% and 30% of patients.…”

Section: Distal Metatarsal Osteotomiesmentioning

confidence: 99%

“…This, combined with a lack of inherent stability resulting in dorsal malunion, has led to reports of transfer metatarsalgia in between 10% and 30% of patients. 33,35 Loss of correction can also occur. Some authors have reported a decrease in these complications by the use of internal fixation in order to increase stability.…”

Section: Distal Metatarsal Osteotomiesmentioning

confidence: 99%

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Modern concepts in the treatment of hallux valgus

Robinson

Limbers

2005

The Journal of Bone and Joint Surgery. British volume

305

177

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More than 130 operations have been described for the treatment of hallux valgus. The plethora of techniques indicates that no single operation is perfect, and none will address all cases. Treatment which is poorly planned or executed leads to high levels of patient dissatisfaction. In recent years, a number of new osteotomies have been described. Determining which to use can be difficult. This review will examine the important factors in choosing the most appropriate techniques. Aetiology and pathogenesisThe wearing of constricting and high heel shoes are extrinsic factors which are important in the development of hallux valgus. 1,2 Heredity is likely to be a major predisposing factor in some patients, with up to 68% of patients showing a familial tendency. 3 The role of pes planus is complex. It is unlikely that it is an important initiating factor in hallux valgus but in the presence of pes planus the progression of hallux valgus is more rapid. This is particularly so in those patients with a compromised medial joint capsule as in rheumatoid arthritis, collagen deficiency or a neuromuscular disorder. 4 The presence of pes planus does not reduce the rate of success of operations for hallux valgus. 5,6 Hypermobility of the first tarsometatarsal joint is thought by some 7,8 to be a causative component in some cases of hallux valgus. In these patients a fusion of the first tarsometatarsal joint (the Lapidus procedure), should be considered for surgical correction as opposed to an osteotomy. There is a correlation between hypermobility of the first ray and hallux valgus, 8-10 and a higher incidence of hypermobility at this site causes a hallux valgus deformity which is painful. 8,11 The accurate clinical assessment of hypermobility of the first ray is difficult. 9 However, a recent cadaver study 12 has shown that correction of a hallux valgus deformity by a distal soft-tissue procedure and a basal crescentic osteotomy significantly reduces hypermobility of the first ray, implying that the hypermobility maybe a secondary phenomenon in some cases.The pathogenesis of hallux valgus has been well described by Stephens. 13 Weakening of the tissues on the medial side of the first metatarsophalangeal joint and erosion of the ridge on the metatarsal head between the medial and lateral sesamoids occur early (Fig. 1). The proximal phalanx drifts into valgus and the metatarsal head into varus. A groove appears on the medial side of the articular cartilage of the metatarsal head as it atrophies from the lack of normal pressure and this gives rise to the apparent prominence of the medial exostosis. The medial bursa develops in response to the excessive pressure of shoes over this prominence. As the soft tissues on the medial side become further attenuated, the metatarsal head moves medially so that the medial sesamoid lies under the eroded metatarsal ridge and the lateral sesamoid articulates with the lateral side of the metatarsal head in the first intermetatarsal space. The tendons of extensor hallucis longus and flexor halluci...

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Section: Distal Metatarsal Osteotomiesmentioning

confidence: 99%

Section: Distal Metatarsal Osteotomiesmentioning

confidence: 99%

Modern concepts in the treatment of hallux valgus

Robinson

Limbers

2005

The Journal of Bone and Joint Surgery. British volume

305

177

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“…2 Mild deformities are usually corrected with a distal osteotomy, while moderate and severe deformities are corrected with diaphyseal or proximal osteotomies. 3,4 Despite several techniques for hallux valgus correction, there is much controversy regarding the best procedure to use in a severe deformity, 5 Mitchell and Scarf osteotomies do not restore the load bearing function of the foot to normal, 6 Mitchell's osteotomy appears to be performed in a variety of different ways 7 , some modifications, such as the planter displacement of the metatarsal head has been shown to be important. 8…”

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confidence: 99%

Complications associated with Mitchell’s Osteotomy for Hallux Valgus Correction: A retrospective hospital review

David-West¹

2011

FAOJ

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Background: A retrospective review of complications in Mitchell's osteotomy for mild to moderate hallux valgus correction, in which all osteotomies were fixed with sutures. Methods: The study evaluated Mitchell's osteotomy from a district General hospital. There were 82 feet in 68 patients (14 patients had bilateral osteotomies). The study included 60 females and 8 males; the mean age being 54 years, and the average follow-up was 9 months (6-24 months). Results: Thirty seven feet (45.0%) had complications, of which 22 feet had recurrence and of these, 9 feet had recurrence plus transfer metatarsalgia, One foot had avascular necrosis, 2 feet with non union, one foot with cock-up deformity and two with infection. In the feet with recurrence (22 feet) there was no correction of the tibial sesamoid position. Conclusions: This study demonstrates that Mitchell's osteotomy for hallux valgus correction fixed with sutures is associated with high recurrence and transfer metatarsalgia.

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“…In other studies that used open techniques in association with soft tissue procedures, the recurrence rate ranged from 0% to 10%. (17,51,52,53) Although some of our cases had an increase in HVA after K -wire removal, the HVA and first IMA were significantly decreased at final follow -up. The Kirschner wire insertion level in the study of Yu-Chuan Lin et al was at the middle of the proximal phalanx.…”

Section: Discussionmentioning

confidence: 93%

“…(52,54) This may be explained by lengthening of the first metatarsal through an oblique distally oriented osteotomy (dorsal arm) and excessive medial capsular tightening may lead to impaired range of motion of the MPI joint. However, this problem can be treated by early passive mobilization of the MPI joint.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus

Enan¹

2012

The Role of Osteotomy in the Correction of Congenital and Acquired Disorders of the Skeleton

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Modified Mitchell Osteotomy for Hallux Valgus

Cited by 45 publications

References 19 publications

Modern concepts in the treatment of hallux valgus

Modern concepts in the treatment of hallux valgus

Complications associated with Mitchell’s Osteotomy for Hallux Valgus Correction: A retrospective hospital review

Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus

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