Mitchell and Golden metatarsal osteotomies for the treatment  of moderate hallux valgus deformity: A comparative analysis

Nadan Mikić; Dušanka Grujoska-Veta; Goran Čobeljić; Ismet Gavankapetanović; Zoran Vukašinović; Ivan Soldatović; Miroslava Popović

doi:10.2298/VSP161230105M

Nadan Mikić Zvezdara University Medical Center, Clinical Department of Orthopaedics and Traumatology, Belgrade, Serbia
Dušanka Grujoska-Veta University Clinic for Orthopaedic Surgery, Skoplje, Republic of North Macedonia
Goran Čobeljić University of Belgrade, Faculty of Medicine, Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
Ismet Gavankapetanović Clinical Center, Clinic of Orthopaedics and Traumatology, Sarajevo, Bosnia and Hercegovina
Zoran Vukašinović University of Belgrade, Faculty of Medicine, Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
Ivan Soldatović University of Belgrade, Faculty of Medicine, Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
Miroslava Popović Zvezdara University Medical Center, Clinical Department of Orthopaedics and Traumatology, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP161230105M

Keywords: hallux valgus;, osteotomy;, surgical procedures, operative;, treatment outcome.

Abstract

Background/Aim. Despite bunion surgery having been performed for more than 100 years, there has yet to be a technique considered as the “Gold Standard”. The aim of the study was to compare postoperative results of Mitchell vs. Golden methods of treating moderate hallux valgus deformity. Methods.This observational case control study included 49 patients (81 feet) who had the Mitchell distal metatarsal osteotomy performed, and 49 patients (77 feet) that had the Golden proximal metatarsal osteotomy performed. The results of treatment were evaluated using Hellal’s modification of the Bonney and McNab classification and the Hallux Metatarsophalangeal Interphalangeal Score (HMIS). The statistical analysis of the results was done, thus the values p < 0.05 were considered statistically significant. Results. Both operative procedures showed successful and statistically significant postoperative results compared to the preoperative status (p < 0.001). Comparative analysis of the results from the Mitchell and Golden procedures, according to the Hellal’s modification of Bonney and McNab classification, proved that there was a high statistically significant difference in favor of the Mitchell method (p < 0.001), whereas the comparison based on the HMIS showed no statistically significant difference (p = 0.123) between the two methods. The estimated results analysis of both procedures, based on the values of hallux valgus angle, intermetatarsal angle, sesamoid position, length of immobilization, treatment duration and complications demonstrated that there was a highly significant difference in favor of the Mitchell method (p < 0.001), whereas the value of the shortening of the first metatarsal bone indicated that the shortening was greater in the Mitchell method (p < 0.001), which goes in favor of the Golden method. Regarding the flexion of the thumb of the feet operated on, there was no statistically significant difference (p = 0.723). Conclusion. The examinations performed indicated that both methods showed good postoperative results, but applying the Mitchell method they were better.

References

REFERENCES

Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: A systematic review and meta-analysis. J Foot Ankle Res 2010; 3: 21.

Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br 2005; 87(8): 1038–4512.

Coull R, Stephens MM. Operative decision making in hallux valgus. Curr Orthopaed 2002; 16(3): 180–6.

Tan MY, Seow KH, Tay BK. The Mitchell distal metatarsal os-teotomy for hallux valgus: The Singapore General Hospital experience. Singapore Med J 1998; 39(12): 547–50.

Richardson, EG. Disorders of the hallux. In: Crenshaw AH, edi-tor. Campbell's Operative Orthopaedics. 12th ed. St. Louis: Mosby-Year Book; 2012. p. 3805–91.

Mitchell CL, Fleming JL, Allen R, Glenney C, Sanford GA. Oste-otomy-bunionectomy for hallux valgus. J Bone Joint Surg Am. A 1958; 40(1): 41–60.

Golden GN. Hallux valgus: The osteotomy operation. Br Med J 1961; 1(5236): 1361–5.

Sarrafin SK. Method of predicting the degree of functional correction of the metatarsus primus varus with a lateral dis-placement osteotomy in hallux valgus. Foot Ankle 1985; 5(6): 322–6.

Helal B. Surgery for adolescent hallux valgus. Clin Orthop Relat Res. 1981; 157: 50–63.

Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, mid-foot, hallux, and lesser toes. Foot Ankle Int 1994; 15(7): 349–53.

Zettl R, Trnka HJ, Easley M, Salzer M, Ritschl P. Moderate to severe hallux valgus deformity: Correction with proximal crescentic osteotomy and distal soft-tissue release. Arch Or-thop Trauma Surg 2000; 120(7–8): 397–402.

Baba AN, Bhat JA, Paljor S, Mir NA, Majid S. Mitchell's oste-otomy in the management of hallux valgus: An Indian per-spective. Indian J Orthop 2009; 43(1): 76–81.

Glynn MK, Dunlop JB, Fitzpatrick D. The Mitchell distal meta-tarsal osteotomy for hallux valgus. J Bone Joint Surg Br 1980; 62-B(2): 188–91.

Blum JL. The modified Mitchell osteotomy-bunionectomy: Indications and technical considerations. Foot Ankle Int 1994; 15(3): 103–6.

Briggs TW, Smith P, McAuliffe TB. Mitchell's osteotomy using internal fixation and early mobilisation. J Bone Joint Surg Br 1992; 74(1): 137–9.

Wu KK. Modified Mitchell's bunionectomy (Wu's bunionec-tomy). Orthopedics 1997; 20(3): 253–7.

Dhukaram V, Hullin MG. Mitchell osteotomy for hallux val-gus: An intermediate follow-up with pedobarographic find-ings. J Bone Joint Surg Br 2006; 88: 19–20. (French)

Galaviz IV, Marquez IX, Penagos PJ, Young ZW. Osteoplastia de Golden modificada para la correccion de hallux valgus y meta-tarso primo varo. Rev Mex Ortop Traum 1999; 13(3): 219–22.

Matsubara N. Surgical resultats of the modified Golden meth-od for hallux valgus. Central Jpn J Orthop Surg Traumatol 1999; 42(3): 611–2. (Japanese)

Malik J, Mathieson I. Clinical usage and influence of radio-graphs in the0 assessment of hallux valgus. J Foot Ankle Surg 2013; 52(3): 291–4.

Christensen PH, Hansen TB. Hallux valgus correction using a modified Hohmann technique. Foot Ankle Int 1995; 16(4): 177–80.

Merkel KD, Katoh Y, Johnson EW Jr, Chao EY. Mitchell osteot-omy for hallux valgus: Long-term follow-up and gait analysis. Foot Ankle 1983; 3(4): 189–96.

Broughton NS, Winson IG. Keller's arthroplasty and Mitchell os-teotomy: A comparison with first metatarsal osteotomy of the long-term results for hallux valgus deformity in the younger female. Foot Ankle 1990; 10(4): 201–5.

Mann RA, Rudicel S, Graves SC. Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteoto-my. A long-term follow-up. J Bone Joint Surg Am 1992; 74(1): 124–9.

Lucijanic I, Bicanic G, Sonicki Z, Mirkovic M, Pecina M. Treat-mant of hallux valgus with three-dimensional modification of Mitchell's osteotomy: Technique and results. J Am Podiatr Med Assoc 2009; 99(2): 167–72.

Smith RW, Reynolds JC, Stewart MJ. Hallux valgus assessment: Report of research committee of American orthopaeidc foot and ankle society. Foot Ankle 1984; 5(2): 92–103.

Dermon H, Petrou K, Tilkeridis T, Kapetsis T, Harduvelis C, Skiti-otis D, et al. Long-term results with Mitchell's Osteotomy ap-plied for hallux valgus. J Bone Joint Surg Br 2003; 85: 227.

Desjardins AL, Hajj C, Racine L, Fallaha M, Bornais S. Mitch-ell's osteotomy in the treatment of hallux valgus. Ann Chir 1993; 47(9): 894–9. PubMed PMID: 8141558

Oye C, Finsen VR. Mitchell's osteotomy of hallux valgus. Tidsskr Nor Laegeforen 1998; 118(24): 3765–7. (Norwegian)