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