Critical evaluation of the modified Lapidus procedure

The modified Lapidus procedure has been used for treatment of hallux abducto valgus for many years, yet only a handful of reports evaluate procedure outcome. The purpose of this investigation was twofold: 1) to provide a retrospective outcome analysis of the modified Lapidus procedure using subjective and objective criteria, and 2) to evaluate procedure outcome in patient populations with differing functional demands: athletes, active patients, and sedentary patients. Thirty-four patients (42 feet) had the modified Lapidus procedure performed by the senior author (R.T.B.) over a 7-year period. Nine patients were lost to follow-up leaving 25 patients (32 feet) for study inclusion. Twenty-three females and two males with average age 44.4 years (range 15-71 years) were evaluated at an average follow-up time of 39 months (range 13-91 months). Evaluation consisted of subjective questionnaire, physical examination, and radiographic assessment. Subjective evaluation revealed that 78% of patients rated surgery "completely" or "very" effective. Athletes demonstrated lower return to preoperative activity levels (30%) than did active patients (86%) and sedentary patients (75%), but this was not statistically significant. Seventy-seven percent of athletes rated surgery "completely" or "very" effective. Postoperative intermetatarsal angle averaged 8.2 degrees (range -2 to 15) and first metatarsophalangeal joint dorsiflexion averaged 62.6 degrees (range 20- 90 degrees). Intermetatarsal angle correction to 10 degrees or less and postoperative first metatarso-phalangeal joint dorsiflexion 45 degrees or greater correlated with improved subjective results. The modified Lapidus procedure is an effective procedure in patients with hypermobility of the first metatarsocuneiform joint. Success is dependent on patient selection, meticulous surgical technique and comprehensive postoperative management.