Elsevier

The Journal of Foot and Ankle Surgery

Volume 47, Issue 6, November–December 2008, Pages 510-514
The Journal of Foot and Ankle Surgery

Original research
The Effect of the Lapidus Arthrodesis on the Medial Longitudinal Arch: A Radiographic Review

https://doi.org/10.1053/j.jfas.2008.06.008Get rights and content

We reviewed the medical records and radiographs of 35 patients (3 males, 32 females; mean age 40.8 years) who underwent isolated, modified Lapidus arthrodesis for forefoot pathology in 39 feet. The purpose of the review was to evaluate the structural radiographic changes of the medial longitudinal arch (MLA) following isolated arthrodesis of the first tarsometatarsal joint. Pre- and postoperative standardized measurements of sagittal plane views of the foot were assessed to examine change in the MLA construct. The talo–first metatarsal angle and medial cuneiform height both had statistically significant changes, 2.97 degrees (range, 0–11.5 degrees) and 3.44 mm (range, 0–13 mm) (P < .0001) respectively. Our findings suggest that the Lapidus arthrodesis may influence the medial longitudinal arch. Level of Clinical Evidence: 2

Section snippets

Study Population

The medical charts of patients that underwent a Lapidus arthrodesis between November 1999 and September 2004, were retrospectively analyzed. Criteria for inclusion in this study were as follows: (1) patients must have undergone an isolated first metatarsocuneiform joint fusion and soft tissue capsular balancing procedure for hallux valgus correction due to first ray insufficiency; (2) subjects must have demonstrated radiographic and clinical evidence of fusion of the first metatarsocuneiform

Results

Thirty-nine feet in 35 patients met the inclusion criteria and were included in the analysis. The mean patient age was 40.8 (range, 8–56 years) years. There were 22 left feet and 17 right feet. All of the patients showed confirmation of first metatarsal-medial cuneiform fusion as evidenced by the radiographic appearance of trabecular bone bridging the arthrodesis site, without evidence of radiolucency; and further confirmation was ascertained by review of the medical records. The average

Discussion

Numerous studies have recognized the role of the Lapidus fusion in the treatment of first ray insufficiency (1, 2, 3, 4, 5). Among the various subjective and objective criteria used to appraise the procedure, differences in pre- and postoperative radiographic angular relationships and distances have traditionally been used to assess the effectiveness of an intervention in regard to reestablishing function of the foot. In fact, angular ranges that approximate normal values have been shown to

Acknowledgment

Statistical analysis was provided by The Division of Research, Kaiser Permanente.

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