By correcting the first metatarsal from its base and stabilising the tarsometatarsal joint, a Lapidus procedure can address a deforming mechanism that a distal operation may not control. Published salvage series have reported useful correction and patient satisfaction in appropriately selected recurrent cases.
It is a fusion, not a larger version of an Austin osteotomy. Bone union, alignment, fixation, smoking status and weight-bearing protocols require particular attention. It is not automatically necessary for every recurrence.
Recurrent deformity with demonstrable first-ray instability.
Large residual intermetatarsal angle not suited to distal correction.
Failed previous osteotomy where correction from the base is advantageous.
Adequate joint and bone assessment to plan fusion position and fixation.
Does a Lapidus procedure make the big-toe joint stiff?
The fusion is at the first tarsometatarsal joint in the midfoot, not the first metatarsophalangeal joint at the base of the big toe. Big-toe joint motion can remain, although overall mechanics change.