Category: Midfoot/Forefoot, Other
Keywords: Ankle Arthritis, Ankle Fusion, Arthrodesis
Introduction/Purpose: Hallux valgus (HV) is the most common forefoot deformity in adults, affecting up to one-third of the population. The Lapidus procedure is a well-documented technique that has become a cornerstone in HV correction. Despite its utility, it is technically demanding, with overall complication rates approaching 20% and risks including malunion, nonunion, and dorsiflexion deformity. A proprietary system incorporating a cutting guide and positioning instruments has been developed to simplify the procedure and improve outcomes. While early reports from designer centers have shown favorable outcomes, independent evaluation is limited. This study presents the first large, non-designer center series reporting radiographic outcomes with this system.
Methods: A retrospective analysis of 128 consecutive patients who underwent triplanar hallux valgus through tarsometatarsal arthrodesis was performed between March 2021 and September 2024 by multiple foot and ankle surgeons at a single institution with a minimum follow-up of 3 months. Institutional review board approval was obtained. Primary outcomes included pre- and postoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), and tibial sesamoid position (TSP). Secondary outcomes included complication rates, nonunion incidence, and hardware removal requirements. Statistical analysis utilized paired t-tests for continuous variables with significance defined as p < 0.05.
Results: The cohort included 101 females (78.9%) and 27 males (21.1%) with a mean age of 54.4 years (range 20–78) and mean follow-up of 11.9 months. Significant radiographic correction was achieved, with mean IMA improving from 16.3° to 5.1° (p < 0.001), HVA from 34.5° to 11.2° (p < 0.001), and TSP from 6.2° to 3.1 (p < 0.001). Nine patients (7%) developed hallux varus, with mean IMA improving from 18.6° to 3.0° but HVA from 37.8° to -10.0°. Asymptomatic nonunion occurred in 10 cases (7.8%), symptomatic nonunion in 4 cases (3.1 %) and delayed union in 6 cases (4.6%). Hardware removal was required in 15 patients (11.7%).
Conclusion: Triplanar hallux valgus correction through tarsometatarsal arthrodesis using a proprietary cutting guide and realignment system demonstrates reliable radiographic correction of the deformity. This study represents the largest reported non-designer series for this system and shows consistent, reproducible correction of moderate to severe hallux valgus with a low risk of symptomatic nonunion. However, the Lapidus procedure remains technically complex, and the overall complication rate of approximately 30% in this study—including painful hardware, hallux varus, delayed union, and asymptomatic nonunion— underscores the need for meticulous surgical technique regardless of instrumentation.
AbstractFirst published online January, 2026
