Mitchell bunionectomy: an analysis of four hundred and thirty personal cases plus a review of the literature.

An analysis of 430 personal cases of Mitchell bunionectomy (517 feet) shows that there were 28 (6.5%) male patients and 402 (93.5%) female patients whose age ranged from 14 to 91 years with an average age of 48.5 years and follow-up periods ranging from 6 months to 14 years and 4 months. One hundred thirty-two (30.7%) second hammer toe operations accompanied these Mitchell bunionectomies, and all 430 patients had their second metatarsals longer than their corresponding first metatarsals by an average of 9.3 mm. The author employed a biplane plantar angulation and closing wedge valgus osteotomy of the first metatarsal neck that reduced the first metatarsophalangeal angle from an average of 30 to 13.8 degrees, and the first intermetatarsal angle from an average of 14.7 to 6.1 degrees, with an average first metatarsal shortening of 4.9 mm. The average lateral displacement of the first metatarsal head was 6.5 mm., and three cases of medial angulation and 13 cases of dorsal displacement of the first metatarsal head were encountered. By personally examining 100 randomly selected post-Mitchell bunionectomy patients, the author found that 85% of them had good to excellent results, and 15% had fair to poor results. Avascular necrosis, nonunion, or osteomyelitis of the first metatarsal was not found in this series. A reasonably short first metatarsal and senior citizens with adequate pedal circulation and healthy first metatarsophalangeal joints were fairly good candidates for Mitchell bunionectomy, and early, full weight bearing in a postbunionectomy toe spica walking cast appeared to be quite desirable. However, painful arthrosis of the first metatarsophalangeal joint, a very short first metatarsal, a very wide first intermetatarsal angle, and dysvascular and diabetic feet are poor candidates for Mitchell bunionectomy.