Hallux valgus surgery or “bunion surgery” is one of the most common surgical procedures for the foot and ankle surgeon. As we continue to gain understanding of this complex deformity, it has become clear that our understanding may be incomplete. The Lapidus procedure was described over 80 years ago and still offers many challenges. Often the choice of a Lapidus procedure is not considered due to the complexity or perceived complications. As the traditional Lapidus procedure relied on multiple freehand steps that can be fraught with error, it was often relegated to be used as a last resort. As our understanding of the hallux valgus deformity has grown it is becoming clear that the anatomic Center of Rotation of Angulation of the deformity may lie at the tarsometatarsal joint. There is also the component of the 3-dimensional nature of the deformity that may be best addressed at this anatomic Center of Rotation of Angulation. With those issues in mind, it was necessary to address the shortcomings of the traditional Lapidus procedure and progress toward more consistent, instrumented steps that could address the 3-dimensional nature of the deformity.
Level of Evidence: Level IV—Technique presentation.