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 Foot/Ankle Test 2: Treatment of Inflammation and Deformity
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The Journal of Bone and Joint Surgery (American) 85:60-65 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

The Lapidus Procedure as Salvage After Failed Surgical Treatment of Hallux Valgus

A Prospective Cohort Study

J. Chris Coetzee, MD, FRCSC, Scott G. Resig, MD, Michael Kuskowski, PhD and Khaled J. Saleh, MD, MSc, FRCSC

Investigation performed at the Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota

J. Chris Coetzee, MD, FRCSC
Scott G. Resig, MD
Khaled J. Saleh, MD, MSc, FRCSC
Department of Orthopaedic Surgery, University of Minnesota School of Medicine, 420 Delaware Street S.E., Box 492, Minneapolis, MN 55455. E-mail address for J.C. Coetzee: coetz001{at}tc.umn.edu

Michael Kuskowski, PhD
Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Recurrent hallux valgus is a relatively common, yet challenging, condition for both the patient and the surgeon. The literature on the treatment of recurrent hallux valgus is sparse. The purpose of this study was to evaluate prospectively the functional outcome and patient satisfaction following the Lapidus procedure for the treatment of recurrent hallux valgus deformity.

Methods: Twenty-four patients with a total of twenty-six symptomatic recurrences of hallux valgus after previous procedures for treatment of the deformity were included in the study. Exclusion criteria included prior fusion procedures on the foot or ankle, a previous Keller or Mayo procedure, insulin-dependent diabetes, peripheral vascular disease, or peripheral neuropathy. A visual analog pain scale and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale were administered preoperatively, at six months postoperatively, and yearly thereafter. Weight-bearing radiographs were also made preoperatively; at six weeks, three months, six months, and one year postoperatively; and yearly thereafter. Patient satisfaction was assessed at the latest follow-up evaluation.

Results: At twenty-four months, the mean score according to the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale had increased from 47.6 to 87.9 points, the mean score according to the visual analog pain scale had improved from 6.2 to 1.4, the mean hallux valgus angle had improved from 37.1° to 17.1°, and the mean intermetatarsal angle had improved from 18° to 8.6°. The patients were very satisfied after 77% of the twenty-six procedures, satisfied after 4%, and somewhat satisfied after 19%; no patient was dissatisfied. There were no cases of hallux varus. Complications included three nonunions, all of which occurred in smokers, and two superficial wound infections.

Conclusion: In appropriately selected patients, the Lapidus procedure is a reliable and effective operation after failed surgical treatment of hallux valgus.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.


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