Effect of the Modified Lapidus Procedure for Hallux Valgus on Foot Width

Abstract

Background: Despite the importance of shoe wear to patients with hallux valgus (HV), few studies have investigated changes in foot width following surgery in this population. The purpose of our study was to determine if the modified Lapidus procedure would effectively decrease foot width in patients with HV. Methods: Thirty-one feet (19 left, 12 right) in 30 patients (29 females, 1 male) who underwent a modified Lapidus procedure in combination with a modified McBride and Akin osteotomy for treatment of HV were included in the study. All patients had preoperative and at least 5-month postoperative imaging, consisting of both weightbearing radiographs and computed tomography (WBCT) scans, which were used to measure bony and soft tissue foot widths pre- and postoperatively by 2 independent observers. Results: Intraclass correlation coefficients (ICCs) demonstrated high interobserver reliability (all ICCs >0.90). Bony foot width decreased significantly, by a mean of 8.9 mm (9.1%) on radiographs and 7.9 mm (8.4%) on WBCT scans ( P < .001). The soft tissue foot width also decreased significantly, by a mean of 6.9 mm (6.3%) on radiographs and 6.7 mm (6.4%) on WBCT scans ( P < .001). Changes in the hallux valgus angle and intermetatarsal angle correlated with changes in bony foot width on WBCTs (both r > 0.4, P < .02). Conclusions: The modified Lapidus procedure in combination with a modified McBride and Akin osteotomy resulted in statistically significant changes in both bony and soft tissue foot width. Patients should be counseled that foot width decreases, on average, by 0.5 to 1 cm. Level of Evidence: Level III, comparative series.

Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus

“…The reductions in bony and soft tissue foot width in our study are similar to a recent study by Conti et al that measured reductions in bony and soft tissue widths after modified Lapidus arthrodesis with a modified McBride and Akin osteotomy. 2 In our study, bony foot width decreased by 10.4 mm (10.8%) compared with 8.9 mm (9.1%) on radiographs in the Conti et al study. Soft tissue width decreased by 7.3 mm (6.8%) in our study compared with 6.9 mm (6.3%) on radiographs in the Conti et al study.…”

“…There are several notable differences between the Conti et al study and our study. 2 The study population in our study was much larger (148 feet in 148 patients) in comparison to the Conti et al study (31 feet in 30 patients). In their study, patients underwent a modified Lapidus arthrodesis (crossed compression screws) in combination with a modified McBride (100% of patients) and an Akin osteotomy (80.6% of patients).…”

“…In addition, all patients in their study underwent a medial eminence resection as part of the modified McBride with an average decrease of 1.8 mm in first metatarsal head size on WBCT scans, which may have confounded the reductions in bony and soft tissue width. 2 In our study, none of the patients underwent a medial eminence resection and only 20% of patients received an Akin osteotomy. This difference may indicate that the triplanar first TMT arthrodesis technique used in our study more reliably and consistently achieved a reduction in bony and soft tissue width without the need for additional procedures.…”

“…The Conti et al study used a crossed compression screw technique for the tarsometatarsal arthrodesis in comparison to the biplanar 90-90 locking plates used for triplanar first TMT arthrodesis in our study. 2 Both techniques used for first tarsometatarsal arthrodesis achieved significant and similar reductions in bony and soft tissue foot widths.…”

“…Although foot width changes after metatarsal osteotomies have been variable and inconsistent, our study and recent evidence demonstrate that the first tarsometatarsal arthrodesis more reliably and consistently leads to reductions in foot width. 2 In our study, patients were permitted early weightbearing in a walking boot. Although one surgeon delayed weightbearing for 2 weeks, the majority of patients were allowed full weightbearing in a walking boot on the day of surgery.…”