Comparative radiographic analysis of the results of treatment of Hallux Valgus deformity according to Mitchell and Keller operative methods

Introduction: Hallux valgus represents a complex progressive deformity of the front part of the foot, with the most distinguished malformation as lateral deviation of the toe. Radiography is extremely important in the decision of the surgical procedure for the best correction of this deformity. Aim: The aim of this work is to show the significance of radiographic examinations in operated patients with Hallux Valgus deformityaccording to Mitchell and Keller techniques. Material and methods: The study included 70 patients having hallux valgus deformity of the foot, and they were divided to two groups. The patients were grouped according their sex, age, the degree of deformity (moderate or severe degree of deformity) and according to radiographic findings. The first group (Group 1) was composed of 35 patients who were treated by osteotomy of the I metatarsal bone according to Mitchell, while the second group (Group 2) was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Radiographic examinations (Method of Hardy and Clapham, Piggott classification, presence and absence of the secondary arthritic and reactive changes of the first metatarsophalangeal joint) were analyzed comparatively during the evaluation. The analyses of the radiographic results were performed pre-operatively and post-operatively for the two groups. Results: According to their sex, the patients were 5 men and 65 women. The average age of the patients in group 1 was 42 years, while for group 2 it was 56 years. There is no significant difference (p > 0.05) in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and I intermetatarsal angle. However, the radiographic analysis of the same angles in both groups, one year post-operatively, showed a high statistically significant difference (p < 0.001). The patients operated by Mitchell's technique, according to Piggott classification, have deviation significantly more often on the I metatarsophalangeal joint of 51.43% as a result of their hallux valgus deformity. Significantly more often, there is a subluxation of 77.14% on the I metatarsophalangeal joint in the patients treated by Keller's technique. The radiographic analysis of the I metatarsophalangeal joint (presence and absence of the secondary arthritic and reactive changes) in both groups, pre-operatively (p < 0.01) and one year post-operatively (p < 0.001), showed a high statistically significant difference. Conclusion: Radiographic analyses were of enormous benefit as in the choice of the decision on the type of the operative procedure and also for the evaluation of the postoperative results.