[Sesamoid bone complex and hallux valgus deformity. A retrospective analysis of 82 Mitchell osteotomies].

The aim of the operative treatment of the hallux valgus deformity is to correct the medial luxation of the first metatarsal head out of the sesamoid complex, the restoration of a congruent joint, the patient after treatment should be painfree. 82 patients were available for an independent clinical and radiological review. The median follow up was 32 months. The evaluation of the results are based on objective and subjective assessment of the patients as well as on radiographic criteria, such as hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal bone, subluxation, lateral positioning of the osteotomized MT I-head and position of the sesamoid complex. Depending on the degree of "lateralisation" of the sesamoid complex seven groups were defined: 0/0, 1/0, 1/1, 2/1, 2/2. 2/3, 3/3 following Appel. Following objective criteria 61% of the patients were evaluated excellent or good, following subjective criteria 77% were evaluated excellent or good. Isolated parallel shifting seems to be sufficient in mild forms of hallux valgus (sesamoid complex group 2/2 or less), while the severe subluxation in the metatarsophalangeal joint (sesamoid complex group 2/3, 3/3) requires an additional lateral wedge osteotomy.