Why The Lapidus Bunionectomy Is The Best Procedure For Severe Bunions

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Neal Blitz, DPM, FACFAS

1. Blitz NM, Lee T, Williams K, Barkan H, DiDimenico LA. Early weight bearing after modified lapidus arthodesis: a multicenter review of 80 cases. J Foot Ankle Surg. 2010; 49(4):357-62.
2. Basile P, Cook EA, Cook JJ. Immediate weight bearing following modified lapidus arthrodesis. J Foot Ankle Surg. 2010; 49(5):459-64.
3. Sorensen MD, Hyer CF, Berlet GC. Results of lapidus arthrodesis and locked plating with early weight bearing. Foot Ankle Spec. 2009; 2(5):227-33.
4. Menke CR, McGlamry MC, Camasta CA. Lapidus arthrodesis with a single lag screw and a locking H-plate. J Foot Ankle Surg. 2011; 50(4):377-82.
5. DeVries JG, Granata JD, Hyer CF. Fixation of first tarsometatarsal arthrodesis: a retrospective comparative cohort of two techniques. Foot Ankle Int. 2011; 32(2):158-62.
6. Klos K, Gueorguiev B, Muckley T, Frober R, Hofmann GO, Schwieger K, Windolf M. Stability of medial locking plate and compression screw versus two crossed screws for lapidus arthrodesis. Foot Ankle Int. 2010; 31(2):158-63.
7. Kazzaz S, Singh D. Postoperative cast necessity after a lapidus arthrodesis. Foot Ankle Int. 2009; 30(8):746-51.
8. Saxena A, Nguyen A, Nelsen E. Lapidus bunionectomy: Early evaluation of crossed lag screws versus locking plate with plantar lag screw. J Foot Ankle Surg. 2009; 48(2):170-9.
9. Blitz NM. Early weightbearing of the Lapidus: is it possible? Podiatry Today. 2004; 17(8):46-52.
10. Bednarz PA, Manoli A 2nd. Modified Lapidus procedure for the treatment of hypermobile hallux valgus. Foot Ankle Int. 21(10):816-21, 2000.
11. Myerson M, Allon S, McGarvey W. Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus. Foot Ankle. 1992; 13(3):107-115.
12. Sangeorzan B, Hansen, S. Modified Lapidus procedure for hallux valgus. Foot Ankle. 1989; 9(6):262-266.
13. Clark HR, Veith RG, Hansen ST Jr. Adolescent bunions treated by the modified Lapidus procedure. Bull Hosp Jt Dis Orthop Inst. 1987; 47(2):109-22.
14. Blitz NM. The versatility of the Lapidus arthrodesis. Clin Podiatr Med Surg. 2009; 26(3):427-41.
15. Blitz NM. Current concepts in medial column hypermobility. Podiatry Today. 2005; 18(6):68-79.
16. Bierman RA, Christensen JC, Johnson CH. Biomechanics of the first ray. Part III. Consequences of Lapidus arthrodesis on peroneus longus function: a three-dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg. 2001; 40(3):125-31.
17. Avino A, Patel S, Hamilton GA, Ford LA. The effect of the Lapidus arthrodesis on the medial longitudinal arch: a radiographic review. J Foot Ankle Surg. 2008; 47(6):510-4.

   For further reading, see “Early Weightbearing Of The Lapidus: Is It Possible?” in the August 2004 issue of Podiatry Today.

   Dr. Blitz also writes a blog for Podiatry Today. For recent blogs, visit http://bit.ly/rJ5nnq .

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Louis W. Nordeen, DPM, FACFASsays: December 2, 2011 at 10:08 am

I have found in over 150 bunions, that the Lapidus is not even comparable to the SCARF. When executed correctly, the SCARF has no comparison. And no joints are destroyed. I just don't get the whole thing with the Lapidus. I get plenty of stabilization with the SCARF, even with hypermobility pre-operatively. I stopped doing the Lapidus because I was getting too much post-op sesamoiditis (even 6 months post-op). The SCARF deserves much more attention and credit, and is very easy to perform through the medial incision. Just a thought. I love the Lapidus in some flatfoot corrections however.

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Vladimir Gertsik DPMsays: December 4, 2011 at 11:44 pm

Before justifying Lapidus, it would be prudent to answer one fundamental question: where is the primary pathology, the MPJ or MC joint? In most patients, it is the MPJ and proper MPJ rebalancing by various means will result in IM angle correction. For example, MPJ fusion will eliminate any need for Lapidus.

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