Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Modified “Lapidus” Procedure: Tarsometatarsal Corrective Osteotomy and Fusion With First Metatarsophalangeal Joint Correction and Realignment


Indications

  • Moderate to severe foot deformity, including

    • Hallux valgus with metatarsus primus varus

    • Hypermobility of the medial column

    • Pes plano abductovalgus

Examination/Imaging

Physical Examination

  • Upon weight bearing, hallux valgus is observed toward a more severe deformity.

  • Proper examination of the foot often will reveal associated hypermobility of the medial column and an equinus contracture of the gastrocnemius. There may also be flatfoot deformity (pes plano abductovalgus).

Treatment Options

  • Several recent papers have questioned the existence and significance of hypermobility of the medial column. Tarsometatarsal (TMT) fusion is important in the realignment and stabilization of the medial column. If hypermobility is not present or significant, then other metatarsal osteotomies can be used to correct the deformity. However, if a basal osteotomy is chosen, the medial column can be stabilized without a fusion by driving the screw across the osteotomy site and through the first TMT joint (1TMT).

Controversies

  • The term hypermobility can be difficult to define. An easy way to visualize it is to think of the TMT/intertarsal region moving in two planes causing a bunion. The bunion with medial column hypermobility is found to have medial–lateral instability as well as dorsiflexion instability. This medial column dorsiflexion can also cause flatfoot, leading to the complex problem of bunion with flatfoot.

  • Correction of the bunion via TMT/intertarsal corrective osteotomy and fusion addresses the bunion deformity as well as flatfoot.

Imaging Studies

  • Radiographs

    • Anteroposterior, oblique, and lateral plane radiographs show the deformity, along with subluxation of the flexor complex/sesamoids.

    • On the anteroposterior view, the medial TMT joints will often show a gap between the first metatarsal (1MT) and second metatarsal (2MT), which may be indicative of hypermobility.

    • The oblique view may show lesser metatarsal overload with cortical hypertrophy (further indicating lack of proper weight bearing by the medial column/1MT).

    • The lateral view may show slight upward subluxation of the 1MT base on the medial cuneiform with dorsiflexion of the medial column (which can be seen at the TMT and calcaneonavicular joints).

  • There is no indication for magnetic resonance imaging, computed tomography, or other imaging studies.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts