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Lapidus Mania Hits Southern California

Doug Richie Jr. DPM FACFAS FAAPSM

Over the years, I have watched with amusement the debate from the podium as my esteemed colleagues state their case for preferring a Lapidus fusion over a base wedge osteotomy to correct alignment of the first ray in the surgical treatment of hallux abducto valgus deformity.

My colleagues have proposed various justifications for the Lapidus including reduction of first ray hypermobility, correction of a first metatarsal–medial cuneiform angle and better intraoperative control over restoring alignment of the first metatarsal. 

Most debates have focused on severe hallux abducto valgus deformity. Rarely have I seen a controversy about correcting medium to mild hallux abducto valgus but this now seems to be a growing trend. At scientific meetings, I often hear colleagues state that a Lapidus is their preferred approach for almost all correction of hallux abducto valgus.

While the Lapidus has gained wild popularity in various geographic regions of our country, specifically Pittsburgh and Seattle, this procedure had been slow to catch on here in California where most trends and fads are born. Apparently, this has changed.

A 60-year-old female recently presented to me for a third opinion regarding surgical recommendations she received from two local podiatric physicians. The first surgeon recommended a distal metaphyseal osteotomy (Austin type) procedure. A younger surgeon disagreed and proposed a Lapidus procedure. The patient recalled that the main reason the younger surgeon had the second opinion was that this procedure had a far better chance of preventing recurrence of deformity.

When I looked at her radiographs (see photos at left and right), I was astounded that anybody would recommend a Lapidus for this patient. I am not aware of any credible published research that has measured the superiority of the Lapidus to prevent recurrence of deformity.

Please look at all of the other radiographic parameters that we evaluate when choosing an appropriate procedure. The angulation of the medial cuneiform-first metatarsal angle is intriguing but do we need a Lapidus to correct this?

I would love to get some input from those who prefer the Lapidus for correction of medium-stage hallux abducto valgus deformity.  

For further reading on the Lapidus, see other articles in Podiatry Today from some esteemed colleagues: “Why The Lapidus Bunionectomy Is the Best Procedure For Severe Bunions” at https://www.podiatrytoday.com/why-lapidus-bunionectomy-best-procedure-severe-bunions and “Why The Lapidus Procedure Is Ideal For Bunions” at https://www.podiatrytoday.com/article/5542 .

 

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