Correlation of Clinical Outcomes and Relative Position of the First Metatarsal After the Modified Lapidus Procedure

• Published in: Foot & ankle international 2024-09, Vol.45 (9), p.979-987
• Main Authors: Cychosz, Chris C., Mizher, Rami, Digiovanni, Grace M., Jones, Agnes Cororaton, Conti, Matthew S., Ellis, Scott J.
• Format: Article
• Language: English
• ISSN: 1071-1007; 1944-7876; 1944-7876
• DOI: 10.1177/10711007241255378

Background: Hallux valgus is a complex 3-dimensional deformity, and the modified Lapidus is a commonly used procedure to correct moderate to severe cases. Shortening and elevation of the first ray can occur with this procedure, which may result in increased pressure on the lesser metatarsal heads. However, there is currently no consensus regarding an accepted length and elevation of the first ray following the modified Lapidus. Therefore, the purpose of this study is to evaluate the impact of the position of the first ray on patient-reported outcome measures. Methods: This retrospective study identified 68 patients (72 feet) who underwent the modified Lapidus bunionectomy over a 4-year period at a single institution with a median follow-up of 24 months (range, 11-35.6 months). Patients were included if they were over 18 years of age, had pre- and postoperative weightbearing computed tomography (WBCT) scans, and preoperative and minimum 1-year postoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores. PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were evaluated and compared pre- and postoperatively. Radiographic parameters were measured and compared before and after surgery. Paired t tests were used to evaluate the significance of pre- to postoperative changes. Differences between cohorts were compared using Mann-Whitney U test for continuous variables or Fisher exact test for categorical variables. Correlation between radiographic measurements and patient-reported outcomes were assessed using the Spearman rank rho estimate and visualized with scatterplots with a linear regression. Results: PROMIS physical function, pain interference, pain intensity, and global physical health improved significantly following the modified Lapidus (all P