The misuse of the Lapidus procedure: re-evaluation of the preoperative criteria.

Fusion of the metatarsocuneiform joint has been documented in the literature for a number of conditions affecting the first ray. The fixation techniques have advanced greatly since Lapidus advocated the procedure, but the indications need to remain rigid and narrow. The review of the literature illustrates numerous complications, and this case presentation specifically depicts the long convalescence of the failed fusion of the first metatarsocuneiform joint. The Lapidus procedure ultimately should be used as a last resort to eliminate painful arthrosis from the metatarsocuneiform joint, reduce severe deformity, or give medial column stability to a paralytic or a spastic foot. If no pathology exists within the metatarsocuneiform joint, then surgeons should use other procedures to correct pathology of the first ray in elective foot surgery.