Critical evaluation of the modified Lapidus procedure

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery

Background:

• The modified Lapidus procedure is a common surgical treatment for hallux abducto valgus.
• Limited studies have evaluated its long-term outcomes and effectiveness across different patient groups.

Purpose of the Study:

• To retrospectively analyze the outcomes of the modified Lapidus procedure using subjective and objective measures.
• To compare procedure outcomes in athletes, active patients, and sedentary patients.

Main Methods:

• Retrospective analysis of 25 patients (32 feet) who underwent the modified Lapidus procedure.
• Evaluation included subjective questionnaires, physical examinations, and radiographic assessments.
• Patients were categorized by functional demand: athletes, active, and sedentary.

Main Results:

• 78% of patients reported the surgery as "completely" or "very" effective.
• Athletes had a lower return to preoperative activity levels (30%) compared to active (86%) and sedentary (75%) patients, though not statistically significant.
• Postoperative intermetatarsal angle ≤10° and first metatarsophalangeal joint dorsiflexion ≥45° correlated with better subjective outcomes.

Conclusions:

• The modified Lapidus procedure is effective for hallux abducto valgus, especially in cases with first metatarsocuneiform joint hypermobility.
• Optimal outcomes depend on appropriate patient selection, precise surgical technique, and thorough postoperative care.
• While athletes showed a trend towards lower return to activity, overall subjective satisfaction remained high across groups.