Hallux Valgus Correction Utilizing Modified Lapidus Procedure with limited Single proximal incision: Surgeon Series

Hallux Valgus Correction Utilizing Modified Lapidus Procedure with limited Single proximal incision: Surgeon Series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hallux Valgus Correction Utilizing Modified Lapidus Procedure with limited Single proximal incision: Surgeon Series AMRO ALHOUKAIL, ABDULLAH ALOTAIBI, ABDULMALIK ALNUJAIDI, BADER ALSUBIE, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7663976/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hallux valgus represents a prevalent foot deformity that produces both valgus deviation of the proximal phalanx and first metatarsal adduction. The Modified Lapidus Procedure includes arthrodesis of the first tarsometatarsal joint as its main correction method. This research assesses the results of our technique of modified Lapidus procedure performed by a single surgeon with the uses of a limited proximal incision while omitting both distal incision and bunionectomy. Methods This is a retrospective cohort study carried out on 53 patients who had the Lapidus operation performed by a single surgeon in single center between August 2018 and May 2023. 32 participants underwent bunionectomy, while 21 did not. Preoperative and postoperative radiographs were analysed for hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate functional results. Results The findings indicated that the mean age of the cohort was 34.74 ± 13.94 years, and majority (94.3%) were female patients. Significant improvements were seen in HVA (35.96° to 14.92°), IMA (16.15° to 6.69°), and DMAA (35.69° to 11.96°). There was no significant difference between Bunionectomy and non-bunionectomy groups in terms of postoperative AOFAS scores. Non-union occurred in 7.5% of patients, and 9.4% required revision surgery with no reported infections. Conclusion Significant functional and radiological improvement in Hallux Valgus Deformity were demonstrate utilizing our technique of modified Lapidus procedure, with low rate of complications. Lapidus procedure effectively lowered HVA, IMA, and DMAA and improved functional and pain scores, regardless of bunionectomy status. Hallux Valgus Lapidus Procedure Bunion Modified Lapidus Arthrodesis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Hallux Valgus is a common foot deformity. It is a complex deformity where the proximal phalanx is in valgus deviation at the first MTP joint, and the first metatarsal bone is adducted at the level of TMT joint. Pronation of the first ray, along with sesamoids subluxation, are also present in most cases, with a varying degree of severity. 1,6,9,11,12 The etiology of hallux valgus is not fully understood. Several Factors play a role in the development of this deformity.4 These factors include, genetic predisposition and anatomical variations, like longer and varus deviated first metatarsal, and more spherical articular surface, which makes the first ray more mobile. Flexible and rigid Flat foot and ligament laxity are also a contributing factor. Biomechanical factors, such as shoes with a narrow toe box has been shown to be associated with hallux valgus deformity. These combined factors will result in repetitive trauma, which may contribute to the development of hallux valgus.9,11,18. The prevalence of hallux valgus, as demonstrated some studies, is more common in female than in male.5,10,13 With age related increase in the prevalence and Severity.3,5,10 Diagnosis of hallux valgus is made after clinical and radiological evaluation, including examination of first ray mobility, presence of a bunion or any other deformity, weight bearing radiographs with increased intermetatarsal and hallux valgus angles. 1,2,6,12 The role of surgical correction of hallux valgus deformity has been well established in the literature.9,14,15 Lapidus procedure as management of hallux valgus deformity is the term used for “arthrodesis of the first tarsometatarsal joint”.7 Over the years, Lapidus procedure has underwent various modifications to the degree that few surgeons nowadays preform the originally described Lapidus technique.8,16,17 The aim of this study is to assess the outcomes of our technique of hallux valgus correction utilizing a modified Lapidus procedure with a limited proximal incision and without the need for distal incision or bunionectomy. we examined the medium- to long-term results, including the radiologic correction and fusion and revision rate. METHODS This is a retrospective cohort study, with a sample size of 53 patients. All patients older than 16 years, who underwent modified Lapidus procedure by the same surgeon in the period between 2018 and 2023 were included, with a minimum of 6 month follow up. Data was collected from existing clinical charts, operative notes, and radiographs of patients done for preoperative planning within 6 months of the surgery and at the last follow up for post-operative radiological measurements. We recorded Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA), First Ray Length, and Sesamoid Position. Sesamoids position was recorded utilizing Hardy and Clapham’s classification. We measured the Functional Outcomes using the American Orthopedic Foot and Ankle Society (AOFAS) score. Bunionectomy as a variation of the surgical intervention and postoperative complications where also recorded. Statistical analysis was performed using SPSS 25 and MEDCALC version 23.0.2. Descriptive statistics are presented as frequencies and percentages for categorical variables (e.g., gender, complications) and as Mean ± Standard Deviation (SD) for continuous variables (e.g., age, angles, scores). The normality of continuous data distributions was assessed using the Kolmogorov-Smirnov test. Comparative analysis between groups (With Bunionectomy vs. Without Bunionectomy) was conducted using independent sample t-tests. Paired sample t-tests were employed to compare pre-operative and post-operative measurements within each group. A p-value of less than 0.05 was considered statistically significant for all tests. Surgical technique: Surgery is done in supine position. Intraoperative silfverskiold test is performed to determine the need for an added Gastrocnemius Recession Procedure. A thigh tourniquet is applied, and the lower limb is prepped and draped to the above knee level. We then shift our attention to the Lapidus procedure. Skin incision is done with a medially based 3 cm incision cantered over the tarsometatarsal joint. Meticulous dissection is done till reaching the joint then opening the joint capsule in line with the skin incision and taking the capsule off the bone dorsally and plantarly. Joint preparation is done with a thin cut using a hand sagittal mini saw, keeping in mind taking more bone from the lateral side than medial. We then utilize a lamina spreader to open the joint space and make sure all the cartilage has been removed to reduce the chance of non-union. We then drill both joint surfaces with 1.8 MM drill bit to the level of bleeding cancellous bone to improve healing. 1.6 MM Kirschner wire is inserted through the skin into the first metatarsal head and used to control the reduction. Proper reduction with correction of the intermetatarsal angle and pronation is done and the reduction is fixed temporarily by percutaneous Kirschner wire entering from the first metatarsal dorsally and directed to the first cuneiform, which will be used later as a guide wire for a compression screw later. Once correction of the intermetatarsal angle as well as the sesamoid reduction is confirmed under fluoroscopy, percutaneous incision using a 15 blade over first web space is made to release the adductor tendon and the lateral capsule of the first metatarsophalangeal joint. A mixture of Demineralized Bone Matrix and Cancellous Chips Allograft is applied next through the medial incision in between the joint surfaces followed by a cannulated compression screw that can be drilled and inserted dorsally over the pre-inserted K-Wire. After joint achieving joint compression, a medial 2.7 MM plate and screw fixation is done next. Wound closure then carried out in layers and skin closed using non-absorbable monofilament suture. CLINICAL AND RADIOLOGICAL PICTURES Pre-Operative clinical picture and radiograph Intra-operative pictures prior to correction Using K-Wire in the first metatarsal head to aid in reduction Concluding the procedure with soft tissue release and bone graft application Intraoperative and post-operative clinical pictures after correction. RESULTS Demographic Data: The study cohort was predominantly female, accounting for 50 participants (94.3%) and only 3 males (5.7%). The average age was 34.74 ± 13.94 years, reflecting a moderately young population with some variability. The mean BMI was 26.83 ± 5.84, falling within the overweight range. Most participants were non-smokers (50 participants, 94.3%), with only 3 smokers (5.7%), and the prevalence of diabetes and dyslipidemia was very low, with 1 participant (1.9%) having diabetes and 3 participants (5.7%) having dyslipidemia. Regarding the procedure, 32 participants (60.4%) underwent bunionectomy, while 21 participants (39.6%) did not.There was no reported infection (0%), and nonunion occurred in 4 participants (7.5%), and revision surgery was required in 5 participants (9.4%). Functional outcomes: The Modified Lapidus Procedure showed the functional outcomes for the patients to be 43.35 ± 5.15 and 43 ± 5.3, with and without bunionectomy, respectively (p = 0.831). Postoperative alignment was excellent across both groups, with mean scores of 14.39 ± 2.02 and 14.26 ± 2.21 for the bunionectomy and non-bunionectomy groups, respectively (p = 0.847). The American Orthopaedic Foot & Ankle Society (AOFAS) scores also showed significant functional recovery, with a slight advantage in the non-bunionectomy group (90.15 ± 19.68) over the bunionectomy group (86.97 ± 15.36), although this difference was not statistically significant (p = 0.543). Radiological Parameters Intermetatarsal Angle (IMA): For the entire cohort, the IMA, a key indicator of the deformity severity, ranged preoperatively from 3.80° to 24.10°, with a mean of 16.15° ± 4.61. Postoperatively, it significantly decreased to a range of 1.00° to 18.00°, with a mean of 6.69° ± 4.23, and for revision cases, the mean was 6.03° ± 2.06, highlighting effective correction and sustained alignment. When analyzed by group, preoperative IMA was slightly smaller in the bunionectomy group (15.43° ± 4.27) compared to the non-bunionectomy group (17.25° ± 4.98), but the difference was not statistically significant (p = 0.177). Postoperative IMA was similar in both groups, at 6.66° ± 3.42 and 6.72° ± 5.31, respectively, with no significant difference (p = 0.967). The reductions were significant within each group, with a mean difference (M.D.) of 9.141° (p < 0.001) in the bunionectomy group and 10.533° (p < 0.001) in the non-bunionectomy group. Hallux Valgus Angle (HVA): For the whole cohort, the HVA ranged preoperatively from 14.20° to 56.00°, with a mean of 35.96° ± 8.18. Postoperatively, it improved to a range of 1.40° to 45.50°, with a mean of 14.92° ± 8.94, and in revision cases, the mean was 14.07° ± 0.81, reflecting substantial alignment correction. By group, the preoperative HVA was slightly lower in the bunionectomy group (34.94° ± 8.65) compared to the non-bunionectomy group (37.52° ± 7.33), but the difference was not significant (p = 0.249). Postoperatively, the mean HVA improved to 14.99° ± 9.12 in the bunionectomy group and 14.8° ± 8.89 in the non-bunionectomy group, with no significant difference (p = 0.942). Within-group reductions were significant, with a mean difference of 20.619° (p < 0.001) in the bunionectomy group and 22.719° (p < 0.001) in the non-bunionectomy group. Distal Metatarsal Articular Angle (DMAA): For the entire cohort, the DMAA ranged preoperatively from 6.60° to 58.90°, with a mean of 35.69° ± 12.17. Postoperatively, it reduced to 1.20° to 53.50°, with a mean of 11.96° ± 10.51, and in revision cases, the mean was 8.1° ± 1.67, suggesting maintained joint congruency after revision. By group, the preoperative DMAA was slightly lower in the bunionectomy group (34.93° ± 12.36) than in the non-bunionectomy group (36.85° ± 12.1), though not significantly different (p = 0.577). Postoperatively, the final means were 12.06° ± 10.96 in the bunionectomy group and 11.82° ± 10.07 in the non-bunionectomy group, with no significant difference (p = 0.935). Reductions within each group were significant, with a mean difference of 23.777° (p < 0.001) in the bunionectomy group and 25.033° (p < 0.001) in the non-bunionectomy group. First Ray Length: For the whole cohort, the first ray length ranged preoperatively from 4.90 cm to 8.20 cm, with a mean of 6.12 ± 0.58 cm. Postoperatively, minimal change was observed, with a range of 4.80 cm to 7.70 cm and a mean of 6.14 ± 0.63 cm, and in revision cases, the mean was 5.63 ± 0.65 cm, reflecting structural integrity. Within groups, the preoperative first ray length was slightly longer in the bunionectomy group (6.22 cm ± 0.59) compared to the non-bunionectomy group (5.99 cm ± 0.56), but the difference was not significant (p = 0.161). Postoperatively, the bunionectomy group maintained a significantly longer first ray length (6.31 cm ± 0.63) compared to the non-bunionectomy group (5.89 cm ± 0.55, p = 0.014). Sesamoid Position: For the entire cohort, the sesamoid position preoperatively showed a mean of 3.92 ± 1.38. Postoperatively, it remained relatively similar, with a mean of 3.94 ± 1.32, and in revision cases, the mean was 5.33 ± 1.53. Within groups, preoperative sesamoid positions means were 3.88 ± 1.52 in the bunionectomy group and 4 ± 1.18 in the non-bunionectomy group, but the difference was not statistically significant (p = 0.739). Postoperative positions means were 3.77 ± 1.45 in the bunionectomy group and 4.19 ± 1.08 in the non-bunionectomy group (p = 0.242). Table 1 Demographic and Clinical Characteristics of Participants (n = 53) Variables Description n (n%) Gender Male 3 (5.7%) Female 50 (94.3%) Age Mean ± SD 34.74 ± 13.94 BMI Mean ± SD 26.83 ± 5.84 Smoking Yes 3 (5.7%) No 50 (94.3%) Diabetes Yes 1 (1.9%) No 52 (98.1%) Dyslipidemia Yes 3 (5.7%) No 50 (94.3%) Procedure With Bunionectomy 32 (60.4%) Without Bunionectomy 21 (39.6%) Infection Yes 0 (0.0%) No 53 (100.0%) Non Union Yes 4 (7.5%) No 49 (92.5%) Revision Yes 5 (9.4%) No 48 (90.6%) Note: Categorical data presented as frequencies; while continuous variables expressed as Mean ± SD Table – 2: Descriptive analysis of radiological and functional parameters of the whole modified Lapidus procedure Variables Minimum Maximum Mean ± SD IMA (PRE) 3.80 24.10 16.15 ± 4.61 IMA (POST) 1.00 18.00 6.69 ± 4.23 HVA (PRE) 14.20 56.00 35.96 ± 8.18 HVA (POST) 1.40 45.50 14.92 ± 8.94 DMAA (PRE) 6.60 58.90 35.69 ± 12.17 DMAA (POST) 1.20 53.50 11.96 ± 10.51 1ST RAY LENGTH (PRE) 4.90 8.20 6.12 ± 0.58 1ST RAY LENGTH (POST) 4.80 7.70 6.14 ± 0.63 SEASAMOID POSITION (PRE) 3.92 ± 1.38 SEASAMOID POSITION (POST) 3.94 ± 1.32 IMA (POST Revision) 4.10 8.20 6.03 ± 2.06 HVA (POST Revision) 13.20 14.80 14.07 ± 0.81 DMAA (POST Revision) 6.30 9.60 8.1 ± 1.67 RAY LENGTH (POST Revision) 5.00 6.30 5.63 ± 0.65 SEASAMOID POSITION (POST Revision) 5.33 ± 1.53 Pain 36.19 ± 6.23 Function 43.19 ± 5.16 ALLIGNMENT 14.33 ± 2.08 AOFAS SCORE 88.19 ± 17.03 Note: Continuous variables expressed as Mean ± SD Table – 3: Comparative analysis of both Lapidus procedure and their parameters Variables With Bunionectomy (n = 32) Without Bunionectomy (n = 21) P - value IMA (PRE) 15.43 ± 4.27 17.25 ± 4.98 0.177 IMA (POST) 6.66 ± 3.42 6.72 ± 5.31 0.967 HVA (PRE) 34.94 ± 8.65 37.52 ± 7.33 0.249 HVA (POST) 14.99 ± 9.12 14.8 ± 8.89 0.942 DMAA (PRE) 34.93 ± 12.36 36.85 ± 12.1 0.577 DMAA (POST) 12.06 ± 10.96 11.82 ± 10.07 0.935 1ST RAY LENGTH (PRE) 6.22 ± 0.59 5.99 ± 0.56 0.161 1ST RAY LENGTH (POST) 6.31 ± 0.63 5.89 ± 0.55 *0.014 SEASAMOID POSITION (PRE) 3.88 ± 1.52 4 ± 1.18 0.739 SEASAMOID POSITION (POST) 3.77 ± 1.45 4.19 ± 1.08 0.242 Pain 36.52 ± 5.73 35.79 ± 6.92 0.715 Function 43.35 ± 5.15 43 ± 5.3 0.831 ALLIGNMENT 14.39 ± 2.02 14.26 ± 2.21 0.847 AOFAS SCORE 86.97 ± 15.36 90.15 ± 19.68 0.543 DISCUSSION This study evaluated the results of our technique of Modified Lapidus Procedure with limited proximal incision and no bunionectomy and compared it to the more traditional modification of Lapidus procedure. It focused on a group of patients predominantly composed of females (94.3%) with a mean age of 34.74 ± 13.94 years. The average BMI of 26.83 ± 5.84 was within the overweight range, and the cohort exhibited low rates of smoking (5.7%), diabetes (1.9%), and dyslipidemia (5.7%). Of the 53 participants, 60.4% underwent bunionectomy, while 39.6% did not. Notably, there were no infections, and 92.5% achieved successful union, with only 9.4% requiring revision surgery. These findings indicate a low complication rate and successful procedural outcomes across the cohort. Postoperative functional scores were excellent in both groups, with comparable alignment (bunionectomy: 14.39 ± 2.02; non-bunionectomy: 14.26 ± 2.21) and high AOFAS scores (bunionectomy: 86.97 ± 15.36; non-bunionectomy: 90.15 ± 19.68). Radiological outcomes demonstrated significant post-operative reductions in several key parameters, including intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMAA). For the entire cohort, mean IMA decreased from 16.15° ± 4.61 preoperatively to 6.69° ± 4.23 postoperatively, while HVA improved from 35.96° ± 8.18 to 14.92° ± 8.94. Both bunionectomy and non-bunionectomy groups showed comparable improvements, with no significant differences in postoperative outcomes. First ray length and sesamoid position remained largely unchanged, maintaining structural integrity and alignment. The radiological improvements across the whole cohort highlight the Lapidus procedure procedure's efficacy in managing hallux valgus deformities, irrespective of the additional interventions of bunionectomy. Both variations of The Modified Lapidus Procedure have demonstrated significant improvements in functional outcomes, including pain reduction and postoperative alignment. Postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were high in both groups, with a slight advantage in the non-bunionectomy group; however, this difference was not statistically significant. These findings align with those of Moerenhout et al., who reported in 2019 high AOFAS scores postoperatively in patients treated with the Lapidus procedure, confirming its ability to restore functionality and improve patient satisfaction ( 1 ). Pain scores were slightly better in the bunionectomy group compared to the non-bunionectomy group, but this difference was not significant. Coughlin and jones reported in 2007 great improvement in pain, and functional outcomes following the Modified Lapidus Procedure. The mean pain score dropped dramatically postoperatively, demonstrating substantial pain relief. Functional outcomes, as measured by the American Orthopaedic Foot and Ankle Society (AOFAS) score, also showed notable enhancement, reflecting improved mobility and quality of life ( 2 ). The pain score result of the current study are consistent with a study published in 2023 by Nishikawa et al., which found significant clinical and functional improvements following the Lapidus procedure, as measured by the Visual Analog Scale (VAS) for pain and AOFAS Scale ( 3 ). The intermetatarsal angle (IMA), a key indicator of hallux valgus severity, showed significant reductions postoperatively in both groups. For the entire cohort, the mean IMA decreased from moderate deformity to near-normal values, demonstrating that both variations of the procedure are effectiveness in achieving alignment correction. Within the bunionectomy group, the reduction was substantial and statistically significant. Our findings are consistent with the findings reported in a study published by Cravey et al., in 2021 who emphasized the Lapidus procedure's superior ability to correct moderate to severe IMAs compared to distal metatarsal osteotomies ( 4 ). The hallux valgus angle (HVA) significantly improved in both groups postoperatively, reflecting the procedure's efficacy in correcting metatarsophalangeal joint deformities. For the entire cohort, HVA values improved to near-normal ranges, with comparable reductions in both the bunionectomy and non-bunionectomy groups. These findings align with the results of a study published in Reily in 2021 who reported that that the Lapidus procedure achieves superior correction of HVA compared to other techniques, particularly in severe deformities ( 5 ). Moreover, the studies published in 1989 by Sangeorzan and Hansen reported the same results with a greater improvement with an average change of 11 degree ( 6 ). The DMAA showed substantial improvement postoperatively in both groups, further highlighting the Modified Lapidus Procedure's ability to correct angular deformities. The mean reductions in DMAA were significant across the cohort and consistent within each group. Similar outcomes were reported by Shah et al in 2022, who noted that the Lapidus procedure provides superior DMAA correction compared to scarf osteotomies, particularly in patients with moderate to severe deformities ( 7 ). The first ray length remained largely unchanged postoperatively for the entire cohort, with minimal variation observed in both groups. The bunionectomy group maintained a slightly longer first ray length compared to the non-bunionectomy group, presumably due to the structural modifications involved in the bunionectomy procedure. This observation aligns with findings from Schmid and Krause which highlighted that the Lapidus procedure preserves the structural integrity of the first ray while effectively correcting deformities ( 8 ). The sesamoid position was measured using Hardy and Clapham’s classification. Our results showed favorable positioning postoperatively, with no statistically significant differences observed between the bunionectomy and non-bunionectomy groups. This finding reflects the procedure's ability to improve forefoot alignment without disrupting the sesamoid apparatus. Even in revision cases, the sesamoid position was well-aligned, suggesting that the procedure continue to provide durable outcomes in the revision setting without introducing complications related to sesamoid displacement. This is consistent with Hwang's observation for other techniques of Hallux valgus correction like Distal Chevron Metatarsal Osteotomy (DCMO) and Simple, Effective, Rapid, Inexpensive Technique (S.E.R.I.) that significantly improved the tibial sesamoid position, though the degree of correction was more substantial with the S.E.R.I. method ( 9 ). Similarly, A Study by Rink-Brüne. reported favorable postoperative sesamoid positions with the Lapidus procedure, emphasizing its anatomical preservation ( 10 ). LIMITATIONS OF THE STUDY The limitations of the current study are mainly due to its retrospective design, small sample size, single-surgeon approach, and single-center setting, which may limit the generalizability and statistical power of the findings. Additionally, the reliance on convenience sampling may introduce bias, as the included cases may not represent the entire spectrum of hallux valgus deformities or the full population undergoing the procedure. The sample is overwhelmingly female (94.3%), with only 5.7% male participants. While hallux valgus is more prevalent in females, this gender imbalance limits the ability to generalize the findings to male patients, whose anatomical and biomechanical differences may affect surgical outcomes. Additionally, the relatively young average age of 34.74 years does not fully reflect the population commonly affected by hallux valgus, particularly older individuals who may present with more advanced deformities or comorbid conditions. The low prevalence of comorbidities such as diabetes (1.9%) and dyslipidemia (5.7%) further reduces the applicability of the results to patients with systemic conditions that can influence healing and surgical outcomes. CONCLUSION The Modified Lapidus Procedure with limited proximal incision and no Bunionectomy demonstrated significant radiological and functional improvements in patients with hallux valgus deformities, achieving reliable correction of the intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMAA), as compared to the traditional Lapidus procedure with Bunionectomy. Improvement in Functional outcomes and pain scores emphasize the procedure’s ability to improve patient quality of life. Furthermore, the favorable postoperative sesamoid position and minimal recurrence rates highlight the durability of the corrections achieved. However, limitations such as the retrospective design, small sample size and the predominance of female and younger age group limit the generalizability of the findings and call for more prospective studies with larger and more representative sample. Declarations The authors declare that they have no competing interests, and no funding was received. ETHICS APPROVAL Ethical approval was obtained from the Ethics Committee at King Fahad Medical City. Written informed consent Author Contribution Contributions list: 1.Literature Search2. Conception3. Design4. Acquisition5. Writing the introduction section 6. Writing the methods section 7. Developing the data collection tool/questionnaire 8. surgical techniqueAMRO ALHOUKAIL (2,7,8)ABDULLAH ALOTAIBI (1,2,3,4,5,6)ABDULMALIK ALNUJAIDI (2,3,4,5)BADER ALSUBIE (1,2,3,4,5,6)SALEM ALTHUWAYKH (2,3,4,5)FAHAD ALSUWAYEH (2,3,4,5)FERAS ALGHOFAILY (2,3,4,5) ACKNOWLEDGEMENTS The authors would like to thank King Fahad Medical City Research Centre for their assistance in data analysis Data Availability The data collected and analysed in this study are available upon request. References Mann RA, editor. (1997). (ii) Hallux valgus. In Current Orthopaedics (Vol. 11). Hecht PJ, Lin TJ. (2014). Hallux valgus. In Medical Clinics of North America (Vol. 98, Issue 2, pp. 227–232). https://doi.org/10.1016/j.mcna.2013.10.007 Piqué-Vidal C, Solé MT, Antich J. Hallux Valgus Inheritance: Pedigree Research in 350 Patients With Bunion Deformity. J Foot Ankle Surg. 2007;46(3):149–54. https://doi.org/10.1053/j.jfas.2006.10.011 . Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. In Journal of Bone and Joint Surgery. J Bone Joint Surg Inc. 2011;93:1650–61. https://doi.org/10.2106/JBJS.H.01630 . Nix S, Smith M, Vicenzino B. (2010). Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. http://www.jfootankleres.com/content/3/1/21 Santrock RD, Smith B. (2018). Hallux Valgus Deformity and Treatment: A Three-Dimensional Approach: Modified Technique for Lapidus Procedure. In Foot and Ankle Clinics (Vol. 23, Issue 2, pp. 281–295). W.B. Saunders. https://doi.org/10.1016/j.fcl.2018.02.001 Lapidus PW. The author’s bunion operation from 1931 to 1959. Clin Orthop. 1960;16(12):119–35. Symeonidis PD, Anderson JG. Orthopaedic forum Original and Modified Lapidus Procedures Proposals for a New Terminology. J Bone Joint Surg. 2021. https://doi.org/10.2106/JBJS.20.01010 . Mann RA, Coughlin MJ. Hallux valgus–etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res. 1981;(157):31–41. PMID: 7249460. Roddy E, Zhang W, Doherty M. Prevalence and associations of hallux valgus in a primary care population. Arthritis Rheum. 2008;59(6):857 – 62. 10.1002/art.23709 . PMID: 18512715. Stephens MMC, Stephens MM, Ortho C. (1994). Pathogenesis of hallux vaigus. In EUR J FOOT ANKLE SURG (Vol. 1). Smith RW, Reynolds JC, Stewart MJ. Hallux Valgus Assessment: Report of Research Committee of American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 1984;5(2):92–103. https://doi.org/10.1177/107110078400500208 . Ferrari J, Hopkinson DA, Linney AD. Size and shape differences between male and female foot bones: is the female foot predisposed to hallux abducto valgus deformity? J Am Podiatr Med Assoc. 2004 Sep-Oct;94(5):434 – 52. 10.7547/0940434 . PMID: 15377719. Geissele AE, Stanton RP. Surgical treatment of adolescent hallux valgus. J Pediatr Orthop. 1990 Sep-Oct;10(5):642-8. 10.1097/01241398-199009000-00014 . PMID: 2394818. Scranton PE Jr, Zuckerman JD. Bunion surgery in adolescents: results of surgical treatment. J Pediatr Orthop. 1984;4(1):39–43. 10.1097/01241398-198401000-00009 . PMID: 6693566. Kopp FJ, Patel MM, Levine DS, Deland JT. The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis. Foot Ankle Int. 2005;26(11):913-7. 10.1177/107110070502601103 . PMID: 16309603. Bednarz PA, Manoli A 2. nd. Modified lapidus procedure for the treatment of hypermobile hallux valgus. Foot Ankle Int. 2000;21(10):816 – 21. 10.1177/107110070002101004 . PMID: 11128011. Coughlin MJ, Roger A, Mann, Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int. 1995;16(11):682 – 97. doi: 10.1177/107110079501601104. PMID: 8589807. Moerenhout K, Chopra S, Crevoisier X. Outcome of the modified Lapidus procedure for hallux valgus deformity during the first year following surgery: A prospective clinical and gait analysis study. Clin Biomech (Bristol). 2019;61:205–10. Epub 2018 Dec 20. PMID: 30594769. Coughlin MJ, Jones CP. Hallux valgus and first ray mobility. A prospective study. J Bone Joint Surg Am. 2007;89(9):1887-98. 10.2106/JBJS.F.01139 . PMID: 17768183. Nishikawa DRC, Duarte FA, Saito GH, de Miranda BR, Pontin PA, Mendes AAM, Prado MP. Impact of forefoot width variation on clinical and functional outcomes following the Lapidus procedure. Eur J Orthop Surg Traumatol. 2023;33(7):2853–8. 10.1007/s00590-023-03506-0 . Epub 2023 Mar 5. PMID: 36871250. Cravey KS, Barron IM, Atway SA, Anthony ML, Monson EK. Intermetatarsal Angle and Hallux Abductus Angle Reduction After First Metatarsophalangeal Joint Arthrodesis in Mild, Moderate, and Severe Hallux Valgus. J Am Podiatr Med Assoc. 2021;111(2):Article_3. 10.7547/19-050 . PMID: 33872362. Reilly ME, Conti MS, Day J, MacMahon A, Chrea B, Caolo KC, Williams N, Drakos MC, Ellis SJ. Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity. Foot Ankle Int. 2021;42(11):1454–1462. doi: 10.1177/10711007211013776. Epub 2021 Jun 4. PMID: 34085579. Sangeorzan BJ, Hansen ST Jr. Modified Lapidus procedure for hallux valgus. Foot Ankle. 1989;9(6):262-6. 10.1177/107110078900900602 . PMID: 2744666. Shah MA, Stirling BE, Gonzalez TA, Jackson JB. Hallux Valgus with Increased DMAA Correction by Modified Lapidus Procedure. Foot Ankle Orthop. 2022;7(4):2473011421S00938. 10.1177/2473011421S00938 . PMCID: PMC9679847. Schmid T, Krause F. The modified Lapidus fusion. Foot Ankle Clin. 2014;19(2):223–33. 10.1016/j.fcl.2014.02.005 . Epub 2014 Mar 21. PMID: 24878411. Hwang YG, Park KH, Han SH. Medial Reduction in Sesamoid Position after Hallux Valgus Correction Surgery Showed Better Outcome in S.E.R.I. Osteotomy than DCMO. J Clin Med. 2023;12(13):4402. 10.3390/jcm12134402 . PMID: 37445453; PMCID: PMC10342565. Rink-Brüne O. Lapidus arthrodesis for management of hallux valgus–a retrospective review of 106 cases. J Foot Ankle Surg. 2004 Sep-Oct;43(5):290-5. 10.1053/j.jfas.2004.07.007 . PMID: 15480403. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7663976","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526935782,"identity":"a914538c-995a-4725-a7f5-1962f5e55eee","order_by":0,"name":"AMRO ALHOUKAIL","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"AMRO","middleName":"","lastName":"ALHOUKAIL","suffix":""},{"id":526935784,"identity":"e27f9d3a-b25e-4531-a989-e2b79f2e438d","order_by":1,"name":"ABDULLAH ALOTAIBI","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"ABDULLAH","middleName":"","lastName":"ALOTAIBI","suffix":""},{"id":526935786,"identity":"d8ca8180-eedf-4308-af3b-97b2e5ecc65d","order_by":2,"name":"ABDULMALIK ALNUJAIDI","email":"","orcid":"","institution":"Prince Sultan Military Medical City","correspondingAuthor":false,"prefix":"","firstName":"ABDULMALIK","middleName":"","lastName":"ALNUJAIDI","suffix":""},{"id":526935788,"identity":"99fc6cd0-f3c3-4cea-899d-6efd5a269fce","order_by":3,"name":"BADER ALSUBIE","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie3PsUvDQBTH8RcexOUdWVsq/geFK4WMyb/SEHDq0FFQMBC4brq6+D+0FELHHA/a5cA1m4SuCkpBMolpi5N6tJvDfYYbDr7wfgCO8w/FgBl4GRAgMlwdPqU1GWTed+KnYI5JZHlIWjQ8LhlMdb4Vy+g8OKOt1OMI+tN85jU3li2UqJ4wKXVzsRjpIoXQrCZIK9uWRKFQSJLFgt+LEsJqLBF8y5anuj1M3VLMtCn1Lnl+kV7zaUmqJOsJxSSRcLRPKpIglOWwh1p1H82aOuwPZbuFQnM5YXFnmR+k/Pa6vI6De950dBFdhGue183H38kPtHvKEwLHcRznF18LF1S3dFJZ3gAAAABJRU5ErkJggg==","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":true,"prefix":"","firstName":"BADER","middleName":"","lastName":"ALSUBIE","suffix":""},{"id":526935790,"identity":"345bb06d-ded4-4911-acb6-b99116f3ca44","order_by":4,"name":"SALEM ALTHUWAYKH","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"SALEM","middleName":"","lastName":"ALTHUWAYKH","suffix":""},{"id":526935791,"identity":"63d72479-8b90-44ce-9229-4568967914d7","order_by":5,"name":"FAHAD ALSUWAYEH","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"FAHAD","middleName":"","lastName":"ALSUWAYEH","suffix":""},{"id":526935792,"identity":"cb14d346-e321-487a-89a1-85133f00d6b7","order_by":6,"name":"FERAS ALGHOFAILY","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"FERAS","middleName":"","lastName":"ALGHOFAILY","suffix":""}],"badges":[],"createdAt":"2025-09-20 09:23:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7663976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7663976/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93337887,"identity":"2d10f050-53b9-437b-ba16-aa4ca73d20c7","added_by":"auto","created_at":"2025-10-12 14:12:53","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3345492,"visible":true,"origin":"","legend":"","description":"","filename":"HVFinalManuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/db6d9a15bb91429427153523.docx"},{"id":93338405,"identity":"bf93d751-4816-420e-9c7c-2cb8a2733404","added_by":"auto","created_at":"2025-10-12 14:20:52","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8574,"visible":true,"origin":"","legend":"","description":"","filename":"bdc8d454144349028ffebe0862bfaeff.json","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/87c58e6f714694239354a62b.json"},{"id":93337891,"identity":"efeb95da-3040-4f2e-bf02-cc77c581daf6","added_by":"auto","created_at":"2025-10-12 14:12:54","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88400,"visible":true,"origin":"","legend":"","description":"","filename":"bdc8d454144349028ffebe0862bfaeff1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/feb6b68e9e0b83ac51bf83ef.xml"},{"id":93336308,"identity":"0def3130-b26a-4018-a43b-8ee1262c2f13","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1124264,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/ab15dc2138dba148e6b32e68.jpeg"},{"id":93337882,"identity":"4988e0e0-f76a-4e02-90f3-e018fc100f0d","added_by":"auto","created_at":"2025-10-12 14:12:52","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90424,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/e5b7f3fbc18fa32b06f29607.jpeg"},{"id":93336307,"identity":"3b168e35-51ca-455c-8dd4-04ab469b2005","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":95620,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/f3c6019503f7ca94060d0f65.jpeg"},{"id":93336313,"identity":"69ad16b2-3336-4cae-be50-5b3f8923123c","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1411052,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/36441e0c3a4b3cdb16a8c611.jpeg"},{"id":93337884,"identity":"76d3e12e-a348-4f69-9a02-2f339796855f","added_by":"auto","created_at":"2025-10-12 14:12:52","extension":"jpeg","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1033203,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/8d5362f28498e3c732f62123.jpeg"},{"id":93338407,"identity":"8b65de4e-b99c-43da-af84-954c4549eb6f","added_by":"auto","created_at":"2025-10-12 14:20:53","extension":"jpeg","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1439261,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/90f08bf81fee6ae5f0813b30.jpeg"},{"id":93336325,"identity":"6d703ea7-826d-40a5-a97e-aaf6f4c89c74","added_by":"auto","created_at":"2025-10-12 14:04:53","extension":"jpeg","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1421968,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/632cc32bbbedcdbdb8151d2b.jpeg"},{"id":93336324,"identity":"36e7c4bc-7c9d-4f17-b2b0-bfb2cdb21c3d","added_by":"auto","created_at":"2025-10-12 14:04:53","extension":"jpeg","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":401011,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/e0af4b485107ea0bc0406c00.jpeg"},{"id":93337885,"identity":"dba308d1-ad58-47ce-8c1f-7281e7086ae7","added_by":"auto","created_at":"2025-10-12 14:12:52","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":396268,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/c23d878f48453be08aa4d255.png"},{"id":93336329,"identity":"c830b29d-12f0-40fa-9cfc-1fcb8a9027ff","added_by":"auto","created_at":"2025-10-12 14:04:53","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":143900,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/ed241bee9bd50c702fb8351b.png"},{"id":93336317,"identity":"7e84852f-333b-4a67-b02c-52c8c32efd98","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155596,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/1439f24e6cdf17b8fd409229.png"},{"id":93336326,"identity":"e1158946-9082-4af1-a645-9a63624c1a9e","added_by":"auto","created_at":"2025-10-12 14:04:53","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":480573,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/a192c5a48723bdff9d75b6f8.png"},{"id":93338406,"identity":"03dff669-c19f-4c2a-b427-1e1c5ff7c807","added_by":"auto","created_at":"2025-10-12 14:20:53","extension":"png","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":343750,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/865ea04d4876a8dc48310f53.png"},{"id":93336320,"identity":"72518182-f3a8-45d6-bea2-c6cf76c5d67a","added_by":"auto","created_at":"2025-10-12 14:04:53","extension":"png","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":507526,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/ef81312da044595d1b215783.png"},{"id":93336328,"identity":"c4a0cc86-317e-4d8e-bddb-2a0a47db35b4","added_by":"auto","created_at":"2025-10-12 14:04:53","extension":"png","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":488056,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/a96908821a316b6ff2ae5d7e.png"},{"id":93336315,"identity":"3a607d18-aad4-4ab3-b652-441c5b59551b","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43822,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/dec51c362a3c70d9a0671fbe.png"},{"id":93337889,"identity":"ac57d0a9-211c-4d67-b689-d4c0b0587998","added_by":"auto","created_at":"2025-10-12 14:12:53","extension":"xml","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84176,"visible":true,"origin":"","legend":"","description":"","filename":"bdc8d454144349028ffebe0862bfaeff1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/53388462c972c1352f120148.xml"},{"id":93336321,"identity":"447bfc9e-14b8-42ac-8d12-73b9005a5016","added_by":"auto","created_at":"2025-10-12 14:04:53","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":95929,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/93e6c90740d9dbf492e2cb31.html"},{"id":93336304,"identity":"bc8125b3-4f4a-4f76-8de0-ff19987b1c4b","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":427134,"visible":true,"origin":"","legend":"\u003cp\u003ePre-Operative clinical picture and radiograph\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/3a23f6d4064647bc6a3e2c6d.jpg"},{"id":93337883,"identity":"e12394ae-f866-42b9-9300-08ffd7881cc3","added_by":"auto","created_at":"2025-10-12 14:12:52","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1177308,"visible":true,"origin":"","legend":"\u003cp\u003eIntra-operative pictures prior to correction\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/2be722b8d26308d09974b836.jpg"},{"id":93336314,"identity":"4f586b24-1174-47e4-b6da-e5ee7952f4ec","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1810758,"visible":true,"origin":"","legend":"\u003cp\u003eUsing K-Wire in the first metatarsal head to aid in reduction\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/de91e7643f6b42853714f4b8.png"},{"id":93336305,"identity":"afcebb9c-0d98-4c1c-b243-ad4eed9e8e9c","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2260468,"visible":true,"origin":"","legend":"\u003cp\u003eConcluding the procedure with soft tissue release and bone graft application\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/a0e8f1047679e290965291cb.png"},{"id":93336311,"identity":"32547aa8-a8a5-4a7b-b0a3-24483950b236","added_by":"auto","created_at":"2025-10-12 14:04:52","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2265416,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative and post-operative clinical pictures after correction.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/24ba743def9e8193f0632bbc.png"},{"id":93549280,"identity":"e0989d1d-30d1-4e64-ab46-87a76c953988","added_by":"auto","created_at":"2025-10-15 04:32:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8193773,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7663976/v1/ef6c846f-94d6-4b3b-9787-7237b8699e64.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hallux Valgus Correction Utilizing Modified Lapidus Procedure with limited Single proximal incision: Surgeon Series","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHallux Valgus is a common foot deformity. It is a complex deformity where the proximal phalanx is in valgus deviation at the first MTP joint, and the first metatarsal bone is adducted at the level of TMT joint. Pronation of the first ray, along with sesamoids subluxation, are also present in most cases, with a varying degree of severity. 1,6,9,11,12\u003c/p\u003e\u003cp\u003eThe etiology of hallux valgus is not fully understood. Several Factors play a role in the development of this deformity.4 These factors include, genetic predisposition and anatomical variations, like longer and varus deviated first metatarsal, and more spherical articular surface, which makes the first ray more mobile. Flexible and rigid Flat foot and ligament laxity are also a contributing factor. Biomechanical factors, such as shoes with a narrow toe box has been shown to be associated with hallux valgus deformity. These combined factors will result in repetitive trauma, which may contribute to the development of hallux valgus.9,11,18. The prevalence of hallux valgus, as demonstrated some studies, is more common in female than in male.5,10,13 With age related increase in the prevalence and Severity.3,5,10\u003c/p\u003e\u003cp\u003eDiagnosis of hallux valgus is made after clinical and radiological evaluation, including examination of first ray mobility, presence of a bunion or any other deformity, weight bearing radiographs with increased intermetatarsal and hallux valgus angles. 1,2,6,12\u003c/p\u003e\u003cp\u003eThe role of surgical correction of hallux valgus deformity has been well established in the literature.9,14,15 Lapidus procedure as management of hallux valgus deformity is the term used for \u0026ldquo;arthrodesis of the first tarsometatarsal joint\u0026rdquo;.7 Over the years, Lapidus procedure has underwent various modifications to the degree that few surgeons nowadays preform the originally described Lapidus technique.8,16,17\u003c/p\u003e\u003cp\u003eThe aim of this study is to assess the outcomes of our technique of hallux valgus correction utilizing a modified Lapidus procedure with a limited proximal incision and without the need for distal incision or bunionectomy. we examined the medium- to long-term results, including the radiologic correction and fusion and revision rate.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis is a retrospective cohort study, with a sample size of 53 patients. All patients older than 16 years, who underwent modified Lapidus procedure by the same surgeon in the period between 2018 and 2023 were included, with a minimum of 6 month follow up.\u003c/p\u003e\u003cp\u003eData was collected from existing clinical charts, operative notes, and radiographs of patients done for preoperative planning within 6 months of the surgery and at the last follow up for post-operative radiological measurements. We recorded Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA), First Ray Length, and Sesamoid Position. Sesamoids position was recorded utilizing Hardy and Clapham\u0026rsquo;s classification. We measured the Functional Outcomes using the American Orthopedic Foot and Ankle Society (AOFAS) score. Bunionectomy as a variation of the surgical intervention and postoperative complications where also recorded.\u003c/p\u003e\u003cp\u003eStatistical analysis was performed using SPSS 25 and MEDCALC version 23.0.2. Descriptive statistics are presented as frequencies and percentages for categorical variables (e.g., gender, complications) and as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation (SD) for continuous variables (e.g., age, angles, scores). The normality of continuous data distributions was assessed using the Kolmogorov-Smirnov test. Comparative analysis between groups (With Bunionectomy vs. Without Bunionectomy) was conducted using independent sample t-tests. Paired sample t-tests were employed to compare pre-operative and post-operative measurements within each group. A p-value of less than 0.05 was considered statistically significant for all tests.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSurgical technique:\u003c/h2\u003e\u003cp\u003eSurgery is done in supine position. Intraoperative silfverskiold test is performed to determine the need for an added Gastrocnemius Recession Procedure. A thigh tourniquet is applied, and the lower limb is prepped and draped to the above knee level. We then shift our attention to the Lapidus procedure. Skin incision is done with a medially based 3 cm incision cantered over the tarsometatarsal joint. Meticulous dissection is done till reaching the joint then opening the joint capsule in line with the skin incision and taking the capsule off the bone dorsally and plantarly. Joint preparation is done with a thin cut using a hand sagittal mini saw, keeping in mind taking more bone from the lateral side than medial. We then utilize a lamina spreader to open the joint space and make sure all the cartilage has been removed to reduce the chance of non-union. We then drill both joint surfaces with 1.8 MM drill bit to the level of bleeding cancellous bone to improve healing. 1.6 MM Kirschner wire is inserted through the skin into the first metatarsal head and used to control the reduction. Proper reduction with correction of the intermetatarsal angle and pronation is done and the reduction is fixed temporarily by percutaneous Kirschner wire entering from the first metatarsal dorsally and directed to the first cuneiform, which will be used later as a guide wire for a compression screw later. Once correction of the intermetatarsal angle as well as the sesamoid reduction is confirmed under fluoroscopy, percutaneous incision using a 15 blade over first web space is made to release the adductor tendon and the lateral capsule of the first metatarsophalangeal joint. A mixture of Demineralized Bone Matrix and Cancellous Chips Allograft is applied next through the medial incision in between the joint surfaces followed by a cannulated compression screw that can be drilled and inserted dorsally over the pre-inserted K-Wire. After joint achieving joint compression, a medial 2.7 MM plate and screw fixation is done next. Wound closure then carried out in layers and skin closed using non-absorbable monofilament suture.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCLINICAL AND RADIOLOGICAL PICTURES\u003c/h3\u003e\n\u003cp\u003ePre-Operative clinical picture and radiograph\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIntra-operative pictures prior to correction\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eUsing K-Wire in the first metatarsal head to aid in reduction\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eConcluding the procedure with soft tissue release and bone graft application\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIntraoperative and post-operative clinical pictures after correction.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDemographic Data:\u003c/p\u003e\u003cp\u003eThe study cohort was predominantly female, accounting for 50 participants (94.3%) and only 3 males (5.7%). The average age was 34.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.94 years, reflecting a moderately young population with some variability. The mean BMI was 26.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84, falling within the overweight range. Most participants were non-smokers (50 participants, 94.3%), with only 3 smokers (5.7%), and the prevalence of diabetes and dyslipidemia was very low, with 1 participant (1.9%) having diabetes and 3 participants (5.7%) having dyslipidemia. Regarding the procedure, 32 participants (60.4%) underwent bunionectomy, while 21 participants (39.6%) did not.There was no reported infection (0%), and nonunion occurred in 4 participants (7.5%), and revision surgery was required in 5 participants (9.4%).\u003c/p\u003e\u003cp\u003eFunctional outcomes:\u003c/p\u003e\u003cp\u003eThe Modified Lapidus Procedure showed the functional outcomes for the patients to be 43.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.15 and 43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3, with and without bunionectomy, respectively (p\u0026thinsp;=\u0026thinsp;0.831). Postoperative alignment was excellent across both groups, with mean scores of 14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02 and 14.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21 for the bunionectomy and non-bunionectomy groups, respectively (p\u0026thinsp;=\u0026thinsp;0.847). The American Orthopaedic Foot \u0026amp; Ankle Society (AOFAS) scores also showed significant functional recovery, with a slight advantage in the non-bunionectomy group (90.15\u0026thinsp;\u0026plusmn;\u0026thinsp;19.68) over the bunionectomy group (86.97\u0026thinsp;\u0026plusmn;\u0026thinsp;15.36), although this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.543).\u003c/p\u003e\u003cp\u003eRadiological Parameters\u003c/p\u003e\u003cp\u003eIntermetatarsal Angle (IMA):\u003c/p\u003e\u003cp\u003eFor the entire cohort, the IMA, a key indicator of the deformity severity, ranged preoperatively from 3.80\u0026deg; to 24.10\u0026deg;, with a mean of 16.15\u0026deg; \u0026plusmn; 4.61. Postoperatively, it significantly decreased to a range of 1.00\u0026deg; to 18.00\u0026deg;, with a mean of 6.69\u0026deg; \u0026plusmn; 4.23, and for revision cases, the mean was 6.03\u0026deg; \u0026plusmn; 2.06, highlighting effective correction and sustained alignment. When analyzed by group, preoperative IMA was slightly smaller in the bunionectomy group (15.43\u0026deg; \u0026plusmn; 4.27) compared to the non-bunionectomy group (17.25\u0026deg; \u0026plusmn; 4.98), but the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.177). Postoperative IMA was similar in both groups, at 6.66\u0026deg; \u0026plusmn; 3.42 and 6.72\u0026deg; \u0026plusmn; 5.31, respectively, with no significant difference (p\u0026thinsp;=\u0026thinsp;0.967). The reductions were significant within each group, with a mean difference (M.D.) of 9.141\u0026deg; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the bunionectomy group and 10.533\u0026deg; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the non-bunionectomy group.\u003c/p\u003e\u003cp\u003eHallux Valgus Angle (HVA):\u003c/p\u003e\u003cp\u003eFor the whole cohort, the HVA ranged preoperatively from 14.20\u0026deg; to 56.00\u0026deg;, with a mean of 35.96\u0026deg; \u0026plusmn; 8.18. Postoperatively, it improved to a range of 1.40\u0026deg; to 45.50\u0026deg;, with a mean of 14.92\u0026deg; \u0026plusmn; 8.94, and in revision cases, the mean was 14.07\u0026deg; \u0026plusmn; 0.81, reflecting substantial alignment correction. By group, the preoperative HVA was slightly lower in the bunionectomy group (34.94\u0026deg; \u0026plusmn; 8.65) compared to the non-bunionectomy group (37.52\u0026deg; \u0026plusmn; 7.33), but the difference was not significant (p\u0026thinsp;=\u0026thinsp;0.249). Postoperatively, the mean HVA improved to 14.99\u0026deg; \u0026plusmn; 9.12 in the bunionectomy group and 14.8\u0026deg; \u0026plusmn; 8.89 in the non-bunionectomy group, with no significant difference (p\u0026thinsp;=\u0026thinsp;0.942). Within-group reductions were significant, with a mean difference of 20.619\u0026deg; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the bunionectomy group and 22.719\u0026deg; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the non-bunionectomy group.\u003c/p\u003e\u003cp\u003eDistal Metatarsal Articular Angle (DMAA):\u003c/p\u003e\u003cp\u003eFor the entire cohort, the DMAA ranged preoperatively from 6.60\u0026deg; to 58.90\u0026deg;, with a mean of 35.69\u0026deg; \u0026plusmn; 12.17. Postoperatively, it reduced to 1.20\u0026deg; to 53.50\u0026deg;, with a mean of 11.96\u0026deg; \u0026plusmn; 10.51, and in revision cases, the mean was 8.1\u0026deg; \u0026plusmn; 1.67, suggesting maintained joint congruency after revision. By group, the preoperative DMAA was slightly lower in the bunionectomy group (34.93\u0026deg; \u0026plusmn; 12.36) than in the non-bunionectomy group (36.85\u0026deg; \u0026plusmn; 12.1), though not significantly different (p\u0026thinsp;=\u0026thinsp;0.577). Postoperatively, the final means were 12.06\u0026deg; \u0026plusmn; 10.96 in the bunionectomy group and 11.82\u0026deg; \u0026plusmn; 10.07 in the non-bunionectomy group, with no significant difference (p\u0026thinsp;=\u0026thinsp;0.935). Reductions within each group were significant, with a mean difference of 23.777\u0026deg; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the bunionectomy group and 25.033\u0026deg; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the non-bunionectomy group.\u003c/p\u003e\u003cp\u003eFirst Ray Length:\u003c/p\u003e\u003cp\u003eFor the whole cohort, the first ray length ranged preoperatively from 4.90 cm to 8.20 cm, with a mean of 6.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 cm. Postoperatively, minimal change was observed, with a range of 4.80 cm to 7.70 cm and a mean of 6.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63 cm, and in revision cases, the mean was 5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65 cm, reflecting structural integrity. Within groups, the preoperative first ray length was slightly longer in the bunionectomy group (6.22 cm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59) compared to the non-bunionectomy group (5.99 cm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56), but the difference was not significant (p\u0026thinsp;=\u0026thinsp;0.161). Postoperatively, the bunionectomy group maintained a significantly longer first ray length (6.31 cm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63) compared to the non-bunionectomy group (5.89 cm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;0.014).\u003c/p\u003e\u003cp\u003eSesamoid Position:\u003c/p\u003e\u003cp\u003eFor the entire cohort, the sesamoid position preoperatively showed a mean of 3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38. Postoperatively, it remained relatively similar, with a mean of 3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32, and in revision cases, the mean was 5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53. Within groups, preoperative sesamoid positions means were 3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 in the bunionectomy group and 4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 in the non-bunionectomy group, but the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.739). Postoperative positions means were 3.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45 in the bunionectomy group and 4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08 in the non-bunionectomy group (p\u0026thinsp;=\u0026thinsp;0.242).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and Clinical Characteristics of Participants (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (n%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50 (94.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50 (94.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52 (98.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDyslipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50 (94.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eProcedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith Bunionectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (60.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithout Bunionectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21 (39.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInfection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNon Union\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49 (92.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eRevision\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (9.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (90.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eNote: Categorical data presented as frequencies; while continuous variables expressed as Mean ± SD\u003c/h3\u003e\n\u003cp\u003eTable \u0026ndash; 2: Descriptive analysis of radiological and functional parameters of the whole modified Lapidus procedure\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMA (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMA (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHVA (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHVA (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDMAA (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.69\u0026thinsp;\u0026plusmn;\u0026thinsp;12.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDMAA (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1ST RAY LENGTH (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1ST RAY LENGTH (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSEASAMOID POSITION (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSEASAMOID POSITION (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMA (POST Revision)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHVA (POST Revision)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDMAA (POST Revision)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRAY LENGTH (POST Revision)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSEASAMOID POSITION (POST Revision)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c3\" namest=\"c2\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.19\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALLIGNMENT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAOFAS SCORE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.19\u0026thinsp;\u0026plusmn;\u0026thinsp;17.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eNote: Continuous variables expressed as Mean ± SD\u003c/h3\u003e\n\u003cp\u003eTable \u0026ndash; 3: Comparative analysis of both Lapidus procedure and their parameters\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith Bunionectomy\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWithout Bunionectomy\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP - value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMA (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMA (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.967\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHVA (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.94\u0026thinsp;\u0026plusmn;\u0026thinsp;8.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.52\u0026thinsp;\u0026plusmn;\u0026thinsp;7.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHVA (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.99\u0026thinsp;\u0026plusmn;\u0026thinsp;9.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDMAA (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.93\u0026thinsp;\u0026plusmn;\u0026thinsp;12.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.85\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.577\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDMAA (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.06\u0026thinsp;\u0026plusmn;\u0026thinsp;10.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.935\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1ST RAY LENGTH (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1ST RAY LENGTH (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e*0.014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSEASAMOID POSITION (PRE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.739\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSEASAMOID POSITION (POST)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.79\u0026thinsp;\u0026plusmn;\u0026thinsp;6.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.715\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALLIGNMENT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.847\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAOFAS SCORE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86.97\u0026thinsp;\u0026plusmn;\u0026thinsp;15.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.15\u0026thinsp;\u0026plusmn;\u0026thinsp;19.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.543\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study evaluated the results of our technique of Modified Lapidus Procedure with limited proximal incision and no bunionectomy and compared it to the more traditional modification of Lapidus procedure. It focused on a group of patients predominantly composed of females (94.3%) with a mean age of 34.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.94 years. The average BMI of 26.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84 was within the overweight range, and the cohort exhibited low rates of smoking (5.7%), diabetes (1.9%), and dyslipidemia (5.7%). Of the 53 participants, 60.4% underwent bunionectomy, while 39.6% did not. Notably, there were no infections, and 92.5% achieved successful union, with only 9.4% requiring revision surgery. These findings indicate a low complication rate and successful procedural outcomes across the cohort. Postoperative functional scores were excellent in both groups, with comparable alignment (bunionectomy: 14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02; non-bunionectomy: 14.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21) and high AOFAS scores (bunionectomy: 86.97\u0026thinsp;\u0026plusmn;\u0026thinsp;15.36; non-bunionectomy: 90.15\u0026thinsp;\u0026plusmn;\u0026thinsp;19.68).\u003c/p\u003e\u003cp\u003eRadiological outcomes demonstrated significant post-operative reductions in several key parameters, including intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMAA). For the entire cohort, mean IMA decreased from 16.15\u0026deg; \u0026plusmn; 4.61 preoperatively to 6.69\u0026deg; \u0026plusmn; 4.23 postoperatively, while HVA improved from 35.96\u0026deg; \u0026plusmn; 8.18 to 14.92\u0026deg; \u0026plusmn; 8.94. Both bunionectomy and non-bunionectomy groups showed comparable improvements, with no significant differences in postoperative outcomes. First ray length and sesamoid position remained largely unchanged, maintaining structural integrity and alignment. The radiological improvements across the whole cohort highlight the Lapidus procedure procedure's efficacy in managing hallux valgus deformities, irrespective of the additional interventions of bunionectomy.\u003c/p\u003e\u003cp\u003eBoth variations of The Modified Lapidus Procedure have demonstrated significant improvements in functional outcomes, including pain reduction and postoperative alignment. Postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were high in both groups, with a slight advantage in the non-bunionectomy group; however, this difference was not statistically significant. These findings align with those of Moerenhout et al., who reported in 2019 high AOFAS scores postoperatively in patients treated with the Lapidus procedure, confirming its ability to restore functionality and improve patient satisfaction (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Pain scores were slightly better in the bunionectomy group compared to the non-bunionectomy group, but this difference was not significant. Coughlin and jones reported in 2007 great improvement in pain, and functional outcomes following the Modified Lapidus Procedure. The mean pain score dropped dramatically postoperatively, demonstrating substantial pain relief. Functional outcomes, as measured by the American Orthopaedic Foot and Ankle Society (AOFAS) score, also showed notable enhancement, reflecting improved mobility and quality of life (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The pain score result of the current study are consistent with a study published in 2023 by Nishikawa et al., which found significant clinical and functional improvements following the Lapidus procedure, as measured by the Visual Analog Scale (VAS) for pain and AOFAS Scale (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe intermetatarsal angle (IMA), a key indicator of hallux valgus severity, showed significant reductions postoperatively in both groups. For the entire cohort, the mean IMA decreased from moderate deformity to near-normal values, demonstrating that both variations of the procedure are effectiveness in achieving alignment correction. Within the bunionectomy group, the reduction was substantial and statistically significant. Our findings are consistent with the findings reported in a study published by Cravey et al., in 2021 who emphasized the Lapidus procedure's superior ability to correct moderate to severe IMAs compared to distal metatarsal osteotomies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe hallux valgus angle (HVA) significantly improved in both groups postoperatively, reflecting the procedure's efficacy in correcting metatarsophalangeal joint deformities. For the entire cohort, HVA values improved to near-normal ranges, with comparable reductions in both the bunionectomy and non-bunionectomy groups. These findings align with the results of a study published in Reily in 2021 who reported that that the Lapidus procedure achieves superior correction of HVA compared to other techniques, particularly in severe deformities (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Moreover, the studies published in 1989 by Sangeorzan and Hansen reported the same results with a greater improvement with an average change of 11 degree (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe DMAA showed substantial improvement postoperatively in both groups, further highlighting the Modified Lapidus Procedure's ability to correct angular deformities. The mean reductions in DMAA were significant across the cohort and consistent within each group. Similar outcomes were reported by Shah et al in 2022, who noted that the Lapidus procedure provides superior DMAA correction compared to scarf osteotomies, particularly in patients with moderate to severe deformities (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe first ray length remained largely unchanged postoperatively for the entire cohort, with minimal variation observed in both groups. The bunionectomy group maintained a slightly longer first ray length compared to the non-bunionectomy group, presumably due to the structural modifications involved in the bunionectomy procedure. This observation aligns with findings from Schmid and Krause which highlighted that the Lapidus procedure preserves the structural integrity of the first ray while effectively correcting deformities (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe sesamoid position was measured using Hardy and Clapham\u0026rsquo;s classification. Our results showed favorable positioning postoperatively, with no statistically significant differences observed between the bunionectomy and non-bunionectomy groups. This finding reflects the procedure's ability to improve forefoot alignment without disrupting the sesamoid apparatus. Even in revision cases, the sesamoid position was well-aligned, suggesting that the procedure continue to provide durable outcomes in the revision setting without introducing complications related to sesamoid displacement. This is consistent with Hwang's observation for other techniques of Hallux valgus correction like Distal Chevron Metatarsal Osteotomy (DCMO) and Simple, Effective, Rapid, Inexpensive Technique (S.E.R.I.) that significantly improved the tibial sesamoid position, though the degree of correction was more substantial with the S.E.R.I. method (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, A Study by Rink-Br\u0026uuml;ne. reported favorable postoperative sesamoid positions with the Lapidus procedure, emphasizing its anatomical preservation (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e"},{"header":"LIMITATIONS OF THE STUDY","content":"\u003cp\u003eThe limitations of the current study are mainly due to its retrospective design, small sample size, single-surgeon approach, and single-center setting, which may limit the generalizability and statistical power of the findings. Additionally, the reliance on convenience sampling may introduce bias, as the included cases may not represent the entire spectrum of hallux valgus deformities or the full population undergoing the procedure.\u003c/p\u003e\u003cp\u003eThe sample is overwhelmingly female (94.3%), with only 5.7% male participants. While hallux valgus is more prevalent in females, this gender imbalance limits the ability to generalize the findings to male patients, whose anatomical and biomechanical differences may affect surgical outcomes. Additionally, the relatively young average age of 34.74 years does not fully reflect the population commonly affected by hallux valgus, particularly older individuals who may present with more advanced deformities or comorbid conditions. The low prevalence of comorbidities such as diabetes (1.9%) and dyslipidemia (5.7%) further reduces the applicability of the results to patients with systemic conditions that can influence healing and surgical outcomes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe Modified Lapidus Procedure with limited proximal incision and no Bunionectomy demonstrated significant radiological and functional improvements in patients with hallux valgus deformities, achieving reliable correction of the intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMAA), as compared to the traditional Lapidus procedure with Bunionectomy. Improvement in Functional outcomes and pain scores emphasize the procedure\u0026rsquo;s ability to improve patient quality of life. Furthermore, the favorable postoperative sesamoid position and minimal recurrence rates highlight the durability of the corrections achieved. However, limitations such as the retrospective design, small sample size and the predominance of female and younger age group limit the generalizability of the findings and call for more prospective studies with larger and more representative sample.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that they have no competing interests, and no funding was received.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL\u003c/strong\u003e\u003cp\u003e Ethical approval was obtained from the Ethics Committee at King Fahad Medical City. Written informed consent\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eContributions list: 1.Literature Search2. Conception3. Design4. Acquisition5. Writing the introduction section 6. Writing the methods section 7. Developing the data collection tool/questionnaire 8. surgical techniqueAMRO ALHOUKAIL (2,7,8)ABDULLAH ALOTAIBI (1,2,3,4,5,6)ABDULMALIK ALNUJAIDI (2,3,4,5)BADER ALSUBIE (1,2,3,4,5,6)SALEM ALTHUWAYKH (2,3,4,5)FAHAD ALSUWAYEH (2,3,4,5)FERAS ALGHOFAILY (2,3,4,5)\u003c/p\u003e\u003ch2\u003eACKNOWLEDGEMENTS\u003c/h2\u003e\u003cp\u003eThe authors would like to thank King Fahad Medical City Research Centre for their assistance in data analysis\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data collected and analysed in this study are available upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMann RA, editor. (1997). (ii) Hallux valgus. In Current Orthopaedics (Vol. 11).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHecht PJ, Lin TJ. (2014). Hallux valgus. In Medical Clinics of North America (Vol. 98, Issue 2, pp. 227\u0026ndash;232). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.mcna.2013.10.007\u003c/span\u003e\u003cspan address=\"10.1016/j.mcna.2013.10.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePiqu\u0026eacute;-Vidal C, Sol\u0026eacute; MT, Antich J. Hallux Valgus Inheritance: Pedigree Research in 350 Patients With Bunion Deformity. J Foot Ankle Surg. 2007;46(3):149\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1053/j.jfas.2006.10.011\u003c/span\u003e\u003cspan address=\"10.1053/j.jfas.2006.10.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. In Journal of Bone and Joint Surgery. J Bone Joint Surg Inc. 2011;93:1650\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2106/JBJS.H.01630\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.H.01630\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNix S, Smith M, Vicenzino B. (2010). Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.jfootankleres.com/content/3/1/21\u003c/span\u003e\u003cspan address=\"http://www.jfootankleres.com/content/3/1/21\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSantrock RD, Smith B. (2018). Hallux Valgus Deformity and Treatment: A Three-Dimensional Approach: Modified Technique for Lapidus Procedure. In Foot and Ankle Clinics (Vol. 23, Issue 2, pp. 281\u0026ndash;295). W.B. Saunders. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.fcl.2018.02.001\u003c/span\u003e\u003cspan address=\"10.1016/j.fcl.2018.02.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLapidus PW. The author\u0026rsquo;s bunion operation from 1931 to 1959. Clin Orthop. 1960;16(12):119\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSymeonidis PD, Anderson JG. Orthopaedic forum Original and Modified Lapidus Procedures Proposals for a New Terminology. J Bone Joint Surg. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2106/JBJS.20.01010\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.20.01010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMann RA, Coughlin MJ. Hallux valgus\u0026ndash;etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res. 1981;(157):31\u0026ndash;41. PMID: 7249460.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoddy E, Zhang W, Doherty M. Prevalence and associations of hallux valgus in a primary care population. Arthritis Rheum. 2008;59(6):857\u0026thinsp;\u0026ndash;\u0026thinsp;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/art.23709\u003c/span\u003e\u003cspan address=\"10.1002/art.23709\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 18512715.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStephens MMC, Stephens MM, Ortho C. (1994). Pathogenesis of hallux vaigus. In EUR J FOOT ANKLE SURG (Vol. 1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith RW, Reynolds JC, Stewart MJ. Hallux Valgus Assessment: Report of Research Committee of American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 1984;5(2):92\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/107110078400500208\u003c/span\u003e\u003cspan address=\"10.1177/107110078400500208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerrari J, Hopkinson DA, Linney AD. Size and shape differences between male and female foot bones: is the female foot predisposed to hallux abducto valgus deformity? J Am Podiatr Med Assoc. 2004 Sep-Oct;94(5):434\u0026thinsp;\u0026ndash;\u0026thinsp;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7547/0940434\u003c/span\u003e\u003cspan address=\"10.7547/0940434\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15377719.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeissele AE, Stanton RP. Surgical treatment of adolescent hallux valgus. J Pediatr Orthop. 1990 Sep-Oct;10(5):642-8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01241398-199009000-00014\u003c/span\u003e\u003cspan address=\"10.1097/01241398-199009000-00014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 2394818.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScranton PE Jr, Zuckerman JD. Bunion surgery in adolescents: results of surgical treatment. J Pediatr Orthop. 1984;4(1):39\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01241398-198401000-00009\u003c/span\u003e\u003cspan address=\"10.1097/01241398-198401000-00009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 6693566.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKopp FJ, Patel MM, Levine DS, Deland JT. The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis. Foot Ankle Int. 2005;26(11):913-7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/107110070502601103\u003c/span\u003e\u003cspan address=\"10.1177/107110070502601103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 16309603.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBednarz PA, Manoli A 2. nd. Modified lapidus procedure for the treatment of hypermobile hallux valgus. Foot Ankle Int. 2000;21(10):816\u0026thinsp;\u0026ndash;\u0026thinsp;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/107110070002101004\u003c/span\u003e\u003cspan address=\"10.1177/107110070002101004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 11128011.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoughlin MJ, Roger A, Mann, Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int. 1995;16(11):682\u0026thinsp;\u0026ndash;\u0026thinsp;97. doi: 10.1177/107110079501601104. PMID: 8589807.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoerenhout K, Chopra S, Crevoisier X. Outcome of the modified Lapidus procedure for hallux valgus deformity during the first year following surgery: A prospective clinical and gait analysis study. Clin Biomech (Bristol). 2019;61:205\u0026ndash;10. Epub 2018 Dec 20. PMID: 30594769.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoughlin MJ, Jones CP. Hallux valgus and first ray mobility. A prospective study. J Bone Joint Surg Am. 2007;89(9):1887-98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/JBJS.F.01139\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.F.01139\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 17768183.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNishikawa DRC, Duarte FA, Saito GH, de Miranda BR, Pontin PA, Mendes AAM, Prado MP. Impact of forefoot width variation on clinical and functional outcomes following the Lapidus procedure. Eur J Orthop Surg Traumatol. 2023;33(7):2853\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00590-023-03506-0\u003c/span\u003e\u003cspan address=\"10.1007/s00590-023-03506-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2023 Mar 5. PMID: 36871250.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCravey KS, Barron IM, Atway SA, Anthony ML, Monson EK. Intermetatarsal Angle and Hallux Abductus Angle Reduction After First Metatarsophalangeal Joint Arthrodesis in Mild, Moderate, and Severe Hallux Valgus. J Am Podiatr Med Assoc. 2021;111(2):Article_3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7547/19-050\u003c/span\u003e\u003cspan address=\"10.7547/19-050\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 33872362.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReilly ME, Conti MS, Day J, MacMahon A, Chrea B, Caolo KC, Williams N, Drakos MC, Ellis SJ. Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity. Foot Ankle Int. 2021;42(11):1454\u0026ndash;1462. doi: 10.1177/10711007211013776. Epub 2021 Jun 4. PMID: 34085579.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSangeorzan BJ, Hansen ST Jr. Modified Lapidus procedure for hallux valgus. Foot Ankle. 1989;9(6):262-6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/107110078900900602\u003c/span\u003e\u003cspan address=\"10.1177/107110078900900602\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 2744666.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah MA, Stirling BE, Gonzalez TA, Jackson JB. Hallux Valgus with Increased DMAA Correction by Modified Lapidus Procedure. Foot Ankle Orthop. 2022;7(4):2473011421S00938. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2473011421S00938\u003c/span\u003e\u003cspan address=\"10.1177/2473011421S00938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMCID: PMC9679847.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchmid T, Krause F. The modified Lapidus fusion. Foot Ankle Clin. 2014;19(2):223\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.fcl.2014.02.005\u003c/span\u003e\u003cspan address=\"10.1016/j.fcl.2014.02.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2014 Mar 21. PMID: 24878411.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHwang YG, Park KH, Han SH. Medial Reduction in Sesamoid Position after Hallux Valgus Correction Surgery Showed Better Outcome in S.E.R.I. Osteotomy than DCMO. J Clin Med. 2023;12(13):4402. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm12134402\u003c/span\u003e\u003cspan address=\"10.3390/jcm12134402\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37445453; PMCID: PMC10342565.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRink-Br\u0026uuml;ne O. Lapidus arthrodesis for management of hallux valgus\u0026ndash;a retrospective review of 106 cases. J Foot Ankle Surg. 2004 Sep-Oct;43(5):290-5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.jfas.2004.07.007\u003c/span\u003e\u003cspan address=\"10.1053/j.jfas.2004.07.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15480403.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hallux Valgus, Lapidus Procedure, Bunion, Modified Lapidus, Arthrodesis","lastPublishedDoi":"10.21203/rs.3.rs-7663976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7663976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHallux valgus represents a prevalent foot deformity that produces both valgus deviation of the proximal phalanx and first metatarsal adduction. The Modified Lapidus Procedure includes arthrodesis of the first tarsometatarsal joint as its main correction method. This research assesses the results of our technique of modified Lapidus procedure performed by a single surgeon with the uses of a limited proximal incision while omitting both distal incision and bunionectomy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis is a retrospective cohort study carried out on 53 patients who had the Lapidus operation performed by a single surgeon in single center between August 2018 and May 2023. 32 participants underwent bunionectomy, while 21 did not. Preoperative and postoperative radiographs were analysed for hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate functional results.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe findings indicated that the mean age of the cohort was 34.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.94 years, and majority (94.3%) were female patients. Significant improvements were seen in HVA (35.96\u0026deg; to 14.92\u0026deg;), IMA (16.15\u0026deg; to 6.69\u0026deg;), and DMAA (35.69\u0026deg; to 11.96\u0026deg;). There was no significant difference between Bunionectomy and non-bunionectomy groups in terms of postoperative AOFAS scores. Non-union occurred in 7.5% of patients, and 9.4% required revision surgery with no reported infections.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSignificant functional and radiological improvement in Hallux Valgus Deformity were demonstrate utilizing our technique of modified Lapidus procedure, with low rate of complications. Lapidus procedure effectively lowered HVA, IMA, and DMAA and improved functional and pain scores, regardless of bunionectomy status.\u003c/p\u003e","manuscriptTitle":"Hallux Valgus Correction Utilizing Modified Lapidus Procedure with limited Single proximal incision: Surgeon Series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:04:47","doi":"10.21203/rs.3.rs-7663976/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"58a27c3c-c401-4734-b7ee-809d1fa2134e","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-15T04:24:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-12 14:04:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7663976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7663976","identity":"rs-7663976","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}