Arthrodesis of the first metatarsal cuneiform joint has been described as a primary procedure for hallux abducto valgus repair since the early 1900s. Popularized by Paul W. Lapidus, this procedure has remained controversial since its introduction, falling in and out of vogue in the orthopedic and podiatric communities. The authors expound their experiences, using modified operative techniques and advanced internal fixation principles, with emphasis on proper patient selection and clinical results.