Do you guys believe in hypermobile 1st ray or are we been fooled by ligamentous laxity? Its more of east vs west coast training. West leans towards lapidus fusion. I know what to look for on xray and clinically when to fuse mtpc joint. Just measuring the hypermobile 1st ray seems bit tricky for me in the clinical setting. If you have a young distance runner pt(age18-45) with a painful bunion and "hypermobile 1st ray" would you do lapidus or austin/proximal osteotomy sparing the joint? Book answer would be lapidus but I believe that should not be the case all the time. Which procedure would be beneficial to the athlete? You might want to do a procedure based on IM, HA etc where it would reduce the pain and reduce the likely hood of having the bunion return. What procedure would you do on your foot or family if you/they love running and want to get back after surgery? Pain should be #1 factor but dont we also want them to get back to running? Decision, Decision!