During the Lapidus procedure, which structure is most at risk?

During the Lapidus procedure, which structure is most at risk?

• A. Tibialis Posterior Tendon
• B. Flexor Hallucis Longus
• C. Peroneus Longus
• D. Flexor Digitorum Longus

Answer: (B)

The important idea here is how the first tarsometatarsal (TMT) joint is accessed during a Lapidus procedure. To fuse this joint, the surgeon works around the base of the first metatarsal and the medial cuneiform, where the flexor hallucis longus tendon travels toward the plantar aspect of the foot to reach the distal phalanx of the big toe. Because this tendon courses right in the area of exposure and is encountered, retracted, or manipulated during the procedure, it is most at risk for injury or irritation. The other tendons mentioned are not as closely involved in the surgical corridor for the 1st TMT fusion, so they’re less at risk.

The important idea here is how the first tarsometatarsal (TMT) joint is accessed during a Lapidus procedure. To fuse this joint, the surgeon works around the base of the first metatarsal and the medial cuneiform, where the flexor hallucis longus tendon travels toward the plantar aspect of the foot to reach the distal phalanx of the big toe. Because this tendon courses right in the area of exposure and is encountered, retracted, or manipulated during the procedure, it is most at risk for injury or irritation. The other tendons mentioned are not as closely involved in the surgical corridor for the 1st TMT fusion, so they’re less at risk.