The Lapidus Procedure: The Evolution From Suture Fixation to Rigid Multiplanar Correction

After nearly 30 years of performing first tarsometatarsal joint fusions in the treatment of hallux valgus deformity, Paul Lapidus described his career experience with this procedure as “most gratifying and warranting continuation.” Modified versions of his original procedure remain effective for treating large transverse plane deformities, but are also a powerful tool for simultaneous correction of sagittal and frontal plane rotational deformities. Recent investigations with weight-bearing computed tomography scan demonstrate that hallux valgus deformities are multiplanar and can have variable subcomponents between patients, suggesting a patient specific approach may yield the most predictable outcomes. We describe our preferred use of the modified Lapidus procedure for treating hallux valgus deformity, and discuss surgical indications, techniques, and complications.