From the Guidelines
Yes, it is possible to still have a hallux valgus after a successful Lapidus bunionectomy, as the procedure does not guarantee a complete correction of the underlying foot mechanics that led to the bunion formation in the first place. The Lapidus procedure, which involves the fusion of the first metatarsocuneiform joint, is considered one of the more definitive bunion surgeries with lower recurrence rates, approximately 5-10% 1. However, recurrence can occur due to several factors, including incomplete correction during the initial surgery, failure of fusion, or continued wearing of improper footwear. Patients with hypermobility, ligamentous laxity, or certain foot types may be at higher risk for recurrence.
Some key points to consider in the management of hallux valgus include:
- The importance of proper footwear with a wide toe box to reduce pressure on the toes
- The potential benefits of custom orthotics to address biomechanical issues
- The possibility of revision surgery in cases where conservative measures are not effective
- The need to maintain a healthy weight and avoid high heels or narrow shoes to reduce the risk of recurrence
It's worth noting that the provided evidence does not directly address the question of hallux valgus recurrence after Lapidus bunionectomy, but rather focuses on the management of lower limb deformities in children with X-linked hypophosphataemia 1. However, the general principles of orthopedic management, including the importance of proper alignment and biomechanics, can be applied to the treatment of hallux valgus. In cases where hallux valgus persists or recurs after Lapidus bunionectomy, a comprehensive evaluation of the underlying foot mechanics and biomechanics is necessary to determine the best course of treatment.
From the Research
Hallux Valgus After Lapidus Bunionectomy
- The Lapidus procedure is a surgical method used to correct hallux valgus deformities, and its success can be influenced by various factors, including the technique used and patient-related factors 2, 3.
- A study published in 2021 found that successful union is possible with low recurrence and complication rates when using a modified Lapidus procedure with intermetatarsal and intercuneiform fusion 2.
- However, another study published in 2014 noted that recurrence of hallux valgus can be a common complication after corrective surgery, and the cause is often multifactorial, including patient-related factors and surgical factors 3.
- The risk of recurrence and complications can be minimized by careful patient selection, proper surgical technique, and adherence to postoperative instructions 4, 5.
Risk Factors for Recurrence
- A study published in 2024 identified several risk factors for revision surgery and hardware removal after Lapidus bunionectomy, including the hallux valgus angle, intermetatarsal angle, and tibial sesamoid position 5.
- The use of a screw for third point of fixation was found to be an independent risk factor for revision surgery, while female sex and third point of fixation were independent risk factors for hardware removal 5.
Outcomes After Lapidus Bunionectomy
- A study published in 2016 found that the modified Lapidus procedure can successfully relieve pain and correct deformity in patients with hallux valgus, and most patients can return to their previous sports and physical activities after surgery 6.
- However, some patients may experience increased difficulty and impaired participation in physical activity postoperatively, highlighting the importance of careful patient selection and counseling 6.