Foot and Ankle International - 2026-07-06 - Journal Article
The Amount of Peroneus Longus Insertion Resection With Modified Lapidus Procedure for Severe Hallux Valgus: Comparative Radiographic Study of 2 Different Osteotomy Methods.
Sakurai S, Nakasa T, Ikuta Y, Ishibashi S, Moriwaki D, Chujo T, Adachi N
Topics
Key Takeaway
Lateral wedge osteotomy at the first metatarsal base (M-method) resects a mean >50% of the peroneus longus insertion, while the cuneiform-based osteotomy (C-method) resects significantly less (p<0.001), with an IMA cutoff of 21.4° identifying feet at highest risk.
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Summary
This study quantified peroneus longus (PL) insertion sacrifice during two lateral wedge osteotomy configurations used in the modified Lapidus procedure for severe hallux valgus (mean IMA not specified but all cases severe). Using radiographic simulation to determine required bone resection to correct IMA to 0° and 3D CT models to map PL insertion anatomy, the M-method (first metatarsal base osteotomy) produced significantly greater resected PL length and percentage than the C-method (medial cuneiform osteotomy). Mean %-rPL exceeded 50% with the M-method, and an IMA of 21.4° was the cutoff above which >50% PL resection was predicted, though the C-method showed no statistically significant difference above and below this threshold.
Key Limitation
The study is a radiographic and CT simulation without intraoperative validation or clinical outcome data, so the functional consequence of PL insertion resection on recurrence, first ray stability, or patient-reported outcomes remains unproven.
Original Abstract
BACKGROUND
Modified Lapidus procedure is well established for severe hallux valgus (HV). Nonetheless, postoperative recurrence remains a clinical concern. Peroneus longus (PL) functions as a dynamic stabilizer of the first ray, and its insertion at the base of the first metatarsal may be partially resected during osteotomy. Notably, PL dysfunction may contribute to recurrence by contributing to postoperative first ray instability. Nevertheless, extent of PL insertion resection during modified Lapidus procedure has not been quantified. This study aimed to evaluate the extent of resected PL insertion during modified Lapidus procedure.
METHODS
We retrospectively reviewed 80 feet from 74 patients with severe HV. We simulated 2 osteotomy methods: lateral wedge osteotomy at the base of the first metatarsal (M-method) and lateral wedge osteotomy at the distal medial cuneiform (C-method). On radiographs, resected lateral edge length of the first metatarsal (rM1-length) to correct intermetatarsal angle (IMA) to 0° was measured. Based on the rM1-length, 3-dimensional computed tomography models were used to measure whole PL insertion length, resected PL insertion length (rPL-length), and percentage of resected PL insertion (%-rPL). These parameters between the M-method and the C-method were compared. Cutoff value of the IMA for diagnosing feet with %-rPL greater than 50% using the M-method was evaluated.
RESULTS
rM1-length, rPL-length, and %-rPL were significantly greater with the M-method than with the C-method (all P < .001). Notably, the mean %-rPL with the M-method exceeded 50%. The IMA cutoff value was 21.4°; however, with the numbers available, no statistically significant difference was detected in the rPL-length and %-rPL with the C-method above and below this cutoff.
CONCLUSION
Lateral wedge osteotomy at the first metatarsal may result in substantial PL insertion resection during the modified Lapidus procedure. Lateral wedge osteotomy of the medial cuneiform bone may better preserve PL insertion and potentially have implications for first ray stability.