Abstract
BackgroundThe Lapidus procedure has become a popular procedure in correcting hallux valgus deformities and has undergone several modifications in an effort to improve the efficacy of the procedure. The senior author modifies this procedure with the addition of an intermetatarsal and intercuneiform fusion. Our hypothesis is that this will improve the procedure outcomes and decrease deformity recurrence.MethodsWe reviewed patient charts who underwent the procedure between 2014 and 2017 performed by the senior author. This yielded 47 reviewable cases, with 34 meeting study criteria. The cases were analyzed for standard hallux valgus measurements (intermetatarsal angle [IMA], hallux valgus angle [HVA]) and fusion on X-ray.ResultsThe results of the study showed partial intermetatarsal and intercuneiform fusion failure in seven (20%) cases, and one case where the great toe fell into varus. These cases were excluded. In the remaining cases, there was a statistically significant improvement in the HVA and IMA between the preoperative X-ray and first postoperative X-ray. Additionally, there was no significant difference between HVA and IMA between first and final postoperative radiographs. There was a significant increase in IMA for the fusion failure cases (p=0.001).ConclusionClinically, our findings demonstrate that successful union is possible with low recurrence and complication rates when using this modification of the Lapidus procedure in patients with hallux valgus deformity.
Highlights
Hallux valgus is a common cause of morbidity in foot and ankle practices, causing pain and decreased quality of life related to the deformity at the first ray [1]
The results of the study showed partial intermetatarsal and intercuneiform fusion failure in seven (20%) cases, and one case where the great toe fell into varus
Our study shows that the modified Lapidus procedure is a viable option for treating hallux valgus
Summary
Hallux valgus is a common cause of morbidity in foot and ankle practices, causing pain and decreased quality of life related to the deformity at the first ray [1]. For patients who have failed conservative management and with moderate-to-severe deformity, the Lapidus and its modified versions have become increasingly popular options to treat the condition operatively [2,3,4,5,6]. One of the biggest reasons for these innovations in construct stability is the potential for recurrence of the bunion deformity. Various authors have studied large patient subsets and report recurrences as high as 8% for Lapidus procedures [2,10,11,12,13,14]. The Lapidus procedure has become a popular procedure in correcting hallux valgus deformities and has undergone several modifications in an effort to improve the efficacy of the procedure. Our hypothesis is that this will improve the procedure outcomes and decrease deformity recurrence
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