The first TMT joint is the most mobile of the Lisfranc joints, allowing the hypermobility that produces a flexible flatfoot and hallux valgus in predisposed individuals. The Lapidus procedure (first TMT arthrodesis) corrects both hypermobility and hallux valgus by eliminating first TMT motion and correcting intermetatarsal angle at the same time. It is now the preferred surgery for hallux valgus with proven first TMT hypermobility.
First TMT hypermobility (dorsal translation >10 mm on loaded lateral foot X-ray or examination) indicates that a metatarsal osteotomy alone for hallux valgus correction will recur. The Lapidus arthrodesis (first TMT fusion with proximal metatarsal correction) provides durable correction by addressing the underlying hypermobility.
Excessive first ray motion producing hallux valgus recurrence after distal osteotomy managed with Lapidus first TMT arthrodesis.
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