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Surgical Strategies: The Lapidus Procedure

In 1934, Paul W. Lapidus published his experience with an operation for the correction of hallux valgus that would later bear his name.10 He did not claim the originality of this operation and readily acknowledged many other surgeons had already reported similar approaches for hallux valgus. With this manuscript, Lapidus intended “to stress the mechanical importance of the metatarsus primus varus, as one of the most frequent and most prominent factors of the hallux valgus deformity.” He described an operation composed of an arthrodesis of the first tarsometatarsal joint, the creation of a bony bridge between the bases of the first and second metatarsals and a distal soft-tissue release and repair similar to the Silver procedure that effectively corrected an atavistic “square foot” that he believed had a congenital predisposition toward hallux valgus. He emphasized the importance of resecting bone only from the lateral portion of the joint while denuding it of its articular cartilage to obtain acceptable correction of the deformity and a condition favorable for fusion. Lapidus refined his indications and modified his operative technique over his career and reported these changes in two subsequent publications.11,12 Over time he concluded that only the subset of the patients with hallux valgus who manifested a fixed metatarsus primus varus and an intermetatarsal angle larger than 15 (later revised to larger than 10 to 12) degrees required more than a distal softtissue procedure. He reported his technique of obtaining an anteroposterior radiograph with the forefoot tightly bandaged to determine the mobility of the first tarsometatarsal joint. He found that leaving the cortical bone chips he had osteotomized from the first and second metatarsals and