Original Research| Volume 50, ISSUE 1, P50-54, January 2011

Modified Mitchell’s Osteotomy for Moderate to Severe Hallux Valgus—An Outcome Study

Published:November 25, 2010DOI:


      The purpose of this study was to evaluate the outcome of a modified technique of Mitchell’s osteotomy for treatment of moderate to severe hallux valgus deformity with the aims of reducing first metatarsal shortening and osteonecrosis. Between February 2001 and December 2007, a total of 69 patients (90 feet) underwent Mitchell’s corrective osteotomy for moderate to severe hallux valgus deformity. Mean duration of follow-up after surgery was 37 months. Clinical outcome was assessed using the AOFAS Hallux Metatarsophalangeal-Interphalangeal score preoperatively; at 6 weeks, 6 months, 12 months postoperatively; and at annual follow-ups thereafter. Standard weight-bearing radiographs were obtained at each visit. Fifty-nine patients (80/90 feet, 89%) were completely satisfied, whereas 10 patients (10/90 feet, 11%) were satisfied with minor reservations owing to minor complications. Global AOFAS score improved from 43.7 (range, 20 to 77) preoperatively to 85.4 (range, 55 to 100) at final follow-up (P < .01). Eighty-eight (98%) of 90 feet were completely pain free. There was a statistically significant improvement in mean hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle at final follow-up. There were no cases of deep infection, nonunion, or osteonecrosis of first metatarsal head. None of the patients had shortening of the first metatarsal bone by more than 3 mm. In conclusion, our modified surgical technique with a combination of bony correction and adequate capsular reefing is a simple procedure to correct moderate to severe hallux valgus deformity that results in high levels of patient satisfaction, successful deformity correction, and controlled shortening of the first metatarsal, as well as minimal recurrence of deformity.)

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mitchell C.L.
        • Fleming J.L.
        • Allen R.
        • Glenney C.
        • Sanford G.A.
        Osteotomy-bunionectomy for hallux valgus.
        J Bone Joint Surg Am. 1958; 40 (discussion 59): 41-58
        • Glynn M.K.
        • Dunlop J.B.
        • Fitzpatrick D.
        The Mitchell distal metatarsal osteotomy for hallux valgus.
        J Bone Joint Surg Br. 1980; 62: 188-191
        • Tan M.Y.
        • Seow K.H.
        • Tay B.K.
        The Mitchell distal metatarsal osteotomy for hallux valgus—the Singapore General Hospital experience.
        Singapore Med J. 1998; 39: 547-550
        • Blum J.L.
        The modified Mitchell osteotomy-bunionectomy: indications and technical considerations.
        Foot Ankle Int. 1994; 15: 103-106
        • Dermon A.
        • Tilkeridis C.
        • Lyras D.
        Long-term results of Mitchell’s procedure for hallux valgus deformity: a 5- to 20-year follow-up in 204 cases.
        Foot Ankle Int. 2009; 30: 16-20
        • Madjarevic M.
        • Kolundzic R.
        • Matek D.
        Mitchell and Wilson metatarsal osteotomies for the treatment of hallux valgus: comparison of outcomes two decades after the surgery.
        Foot Ankle Int. 2006; 27: 877-882
        • Meier P.J.
        • Kenzora J.E.
        The risks and benefits of distal first metatarsal osteotomies.
        Foot Ankle. 1985; 6: 7-17
        • Laughlin T.J.
        Complications of distal first metatarsal osteotomies.
        J Foot Ankle Surg. 1995; 34 (discussion 593): 524-531
        • Yamamoto K.
        • Imakiire A.
        • Katori Y.
        • Masaoka T.
        • Koizumi R.
        Clinical results of modified Mitchell’s osteotomy for hallux valgus augmented with oblique lesser metatarsal osteotomy.
        J Orthop Surg (Hong Kong). 2005; 13: 245-252
        • Kitaoka H.B.
        • Alexander I.J.
        • Adelaar R.S.
        Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.
        Foot Ankle Int. 1994; 15: 349-353
        • Smith R.W.
        • Reynolds J.C.
        • Stewart M.J.
        Hallux valgus assessment: report of research committee of American Orthopaedic Foot and Ankle Society.
        Foot Ankle. 1984; 5: 92-103
        • Hardy R.H.
        • Clapham J.C.R.
        Observations on hallux valgus; based on a controlled series.
        J Bone Joint Surg Br. 1951; 33: 376-391
        • Miller J.W.
        Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery.
        J Bone Joint Surg Am. 1974; 56: 923-931
        • Zlotoff H.
        Shortening of the first metatarsal following osteotomy and its clinical significance.
        J Am Podiatry Assoc. 1977; 67: 412-426
        • Hart E.S.
        • deAsla R.J.
        • Grottkau B.E.
        Current concepts in the treatment of hallux valgus.
        Orthop Nurs. 2008; 27 (quiz 281): 274-280
        • Das De S.
        • Hamblen D.L.
        Distal metatarsal osteotomy for hallux valgus in the middle-aged patient.
        Clin Orthop Relat Res. 1987; : 239-246
        • Teli M.
        • Grassi F.A.
        • Montoli C.
        • Moalli S.
        • Pazzaglia U.E.
        The Mitchell bunionectomy: a prospective study of 60 consecutive cases utilizing single K-wire fixation.
        J Foot Ankle Surg. 2001; 40: 144-151
        • O’Malley M.J.
        • Chao W.
        • Thompson F.M.
        Treatment of established nonunions of Mitchell osteotomies.
        Foot Ankle Int. 1997; 18: 77-80
        • Wu K.K.
        Wu’s bunionectomy: a clinical analysis of 150 personal cases.
        J Foot Surg. 1992; 31: 288-297
        • Das De S.
        Distal metatarsal osteotomy for adolescent hallux valgus.
        J Pediatr Orthop. 1984; 4: 32-38
        • Merkel K.D.
        • Katoh Y.
        • Johnson E.W.
        • Chao E.Y.
        Mitchell osteotomy for hallux valgus: long-term follow-up and gait analysis.
        Foot Ankle. 1983; 3: 189-196
        • Shereff M.J.
        • Yang Q.M.
        • Kummer F.J.
        Extraosseous and intraosseous arterial supply to the first metatarsal and metatarsophalangeal joint.
        Foot Ankle. 1987; 8: 81-93
        • Austin D.W.
        • Leventen E.O.
        A new osteotomy for hallux valgus: a horizontally directed “V” displacement osteotomy of the metatarsal head for hallux valgus and primus varus.
        Clin Orthop Relat Res. 1981; : 25-30
        • Kinnard P.
        • Gordon D.
        A comparison between Chevron and Mitchell osteotomies for hallux valgus.
        Foot Ankle. 1984; 4: 241-243
        • Briggs T.W.
        • Smith P.
        • McAuliffe T.B.
        Mitchell’s osteotomy using internal fixation and early mobilisation.
        J Bone Joint Surg Br. 1992; 74: 137-139
        • Wu K.K.
        Mitchell’s bunionectomy and Wu’s bunionectomy: a comparison of 100 cases of each procedure.
        Orthopedics. 1990; 13: 1001-1007