title: Long-term results of Mitchell's procedure for hallux valgus deformity: a 5- to 20-year followup in 204 cases.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Amalia Flemig General Hospital, Athens, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Dermon
authors.forename: Constantinos
authors.initials: C
authors.lastname: Tilkeridis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Lyras
authors.forename: Marios
authors.initials: M
authors.lastname: Tryfonidis
authors.forename: Charis
authors.initials: C
authors.lastname: Petrou
authors.forename: Stavrakis
authors.initials: S
authors.lastname: Tzanis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kazakos
authors.forename: Georgios
authors.initials: G
authors.lastname: Petrou
mesh_terms: D000328:Adult; D000368:Aged; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D037061:Metatarsalgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D010027:Osteotomy; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult