Lapidus Procedure for Adolescent Hallux Valgus Surgical/Technical Tips

Abstract

Surgical correction of adolescent hallux valgus (AHV) is accompanied by high rates of recurrence, so surgery in the adolescent age group should only be undertaken in insistent patients with pain refractory to nonoperative measures. A subset of patients with AHV may manifest hypermobility of the 1^st tarsometatarsal joint (TMTJ) which may lead to recurrence. The Lapidus or modified Lapidus procedure involves TMTJ fusion and when done properly is a powerful and durable procedure for correcting metatarsus primus varus (MPV) and thus hallux valgus. Furthermore, it can reliably correct pronation of the 1^st metatarsal which is likely a contributor to recurrence.  However, many pediatric orthopedists may be unfamiliar with this operation. The current paper discusses the patient evaluation and preferred technique for performance of the Lapidus procedure.