title: Modified Mitchell osteotomy alone does not have higher rate of residual metatarsalgia than combined first and lesser metatarsal osteotomy.
abstract: 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.
authors.affiliation: Department of Orthopaedics, Pingtung Hospital, Pingtung, Taiwan; Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shu-Jung
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Pingtung Hospital, Pingtung, Taiwan; Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yuh-Min
authors.initials: YM
authors.lastname: Cheng
authors.affiliation: Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Sung-Yen
authors.initials: SY
authors.lastname: Lin
authors.affiliation: Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chung-Hwan
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
authors.forename: Hsuan-Ti
authors.initials: HT
authors.lastname: Huang
authors.affiliation: Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: roger01@ms4.hinet.net.
authors.forename: Peng-Ju
authors.initials: PJ
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D037061:Metatarsalgia / Q000000981:diagnostic imaging / Q000209:etiology; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies
keywords: Hallux valgus; Metatarsalgia; Mitchell osteotomy; Plantar callosity; Sliding oblique metatarsal osteotomy
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