Abstract
Surgical correction of adolescent hallux valgus (AHV) is accompanied by high rates of recurrence. Thus, surgery in the adolescent age group should only be undertaken in fully informed patients with pain refractory to nonoperative measures. A subset of patients with AHV may manifest hypermobility of the 1(st) tarsometatarsal joint (TMTJ), which may lead to recurrence. The Lapidus or modified Lapidus procedure involves TMTJ fusion and is a powerful and durable procedure for correcting metatarsus primus varus (MPV) and thus hallux valgus. Furthermore, it can reliably correct pronation of the 1(st) metatarsal, which may contribute to high recurrence rates. As many pediatric orthopaedists may be unfamiliar with this operation, we discuss patient evaluation and preferred technique for the performance of the Lapidus procedure. Key Concepts•Hypermobility of the 1(st) ray leads to metatarsus primus varus and hallux valgus and is likely a mechanism for recurrence after AHV surgery.•Standing radiographs disclose an increased 1(st)/2(nd) intermetatarsal angle (IMA) and excessive dorsiflexion of the 1(st) ray. Hypertrophy of the cortex of the 2(nd) metatarsal is variable.•1(st) TMTJ fusion can result in lasting correction of MPV and AHV.•It is imperative that cartilage resection proceeds all the way plantar (3 cm) to allow for adequate plantarflexion of the 1(st) ray. Minimal resection prevents excessive shortening and internal fixation should be rigid.