Utilization of the Modified Lapidus Procedure for Correction of Moderate to Severe Hallux Valgus Deformity With Increased Distal Metatarsal Articular Angle

Abstract

Background: Hallux valgus, a common deformity treated by orthopaedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Thus, we investigated the efficacy of the modified Lapidus procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery. Methods: A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a modified Lapidus procedure between April 26, 2018, and November 19, 2020. Exclusion criteria included patients with inadequate follow-up. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and DMAA were measured on preoperative weight-bearing, 2-week postoperative non-weight-bearing, and at final follow-up weight-bearing radiographs. Results: The study included a total of 99 cases of modified Lapidus procedure for hallux valgus on 85 subjects. On radiologic assessment, the average DMAA decreased from 17.72 ± 6.18 degrees preoperatively to 9.19 ± 5.19 degrees 2 weeks postoperatively (P < .0001) and 9.79 ± 4.62 degrees at the final follow-up (P < .0001). The average HVA decreased from 31.34 ± 10.39 degrees preoperatively to 13.34 ± 6.16 degrees 2 weeks postoperatively (P < .0001) and 15.05 ± 7.43 degrees at final follow-up (P < .0001). Last, the IMA decreased from 14.99 ± 3.82 degrees preoperatively (P < .0001) to 4.66 ± 2.59 degrees 2 weeks postoperatively and 6.62 ± 3.46 degrees at final follow-up (P < .0001). The recurrence rate was 3.03%. Conclusion: The modified Lapidus procedure is an effective procedure in correcting the HVA, IMA, and DMAA in hallux valgus surgery without the need for additional distal or proximal metatarsal osteotomies. Surgeons should consider this technique in patients with moderate to severe hallux valgus deformity who may require correction of their DMAA. Level of Evidence: Level IV-Retrospective comparative study.