Foot & Ankle Procedures

Lapidus Procedure for Bunions

Overview

TMT Joint - Lapidus compressedHallux valgus is the medical term for a bunion.  The first tarsal-metatarsal (TMT) joint is an important joint in the inner part of the middle of the foot.  The two bones that meet to form this joint are the first metatarsal and the medial cuneiform bones.  When this joint has too much looseness or movement, the condition if known as hypermobility or instability.  When this joint becomes hypermobile, the first metatarsal moves too much in one direction and the first toe compensates by moving too much in the other direction. When this happens, a bunion develops.

What is the Lapidus Procedure

The Lapidus procedure is a type of fusion of the first TMT joint that decreases the movement of that joint and straightens out the first metatarsal and toe. This procedure is used to treat bunions caused by first TMT joint hypermobility.

What is the goal of the Lapidus procedure?

The goal of the Lapidus procedure is to surgically treat a bunion that is caused by first TMT joint hypermobility. An orthopaedic foot and ankle surgeon realigns the big toe by placing the first metatarsal straight with the medial cuneiform bone and locking or fusing these two bones together. When the first TMT joint is fused, the first metatarsal will not move abnormally. This will allow the first toe to stay straight and prevent the bunion from coming back.

What signs indicate surgery might be necessary?

Indications for the Lapidus procedure may include:

  1. Pain at the bunion. Patients with a painful bunion have a bump on their big toe joint. Typically this bump causes pain when it rubs the inside of a shoe.
  2. Pain and/or hypermobility at the first TMT joint.
  3. Difficulties wearing shoes. When patients have a severe enough bunion, the foot can be so wide that it is difficult to find shoes that fit.
  4. Pain that does not improve with conservative treatments such as wearing wide-toe shoes.

When should I avoid surgery?

Surgery should be avoided for the following reasons:

  1. If you have no pain from your bunion and/or your first TMT joint hypermobility.
  2. If your bunion is not due to first TMT joint hypermobility. While your bunion could still receive a surgical correction, the procedure would not be a Lapidus procedure.
  3. If you have any signs or symptoms of a bone or skin infection. Performing foot surgery when you have a foot infection can make the infection worse.
  4. If you have poor circulation in your foot. Performing foot surgery when you have poor foot circulation can lead to problems with surgical wound healing.

Aftercare

Immediately after surgery, patients need to keep dressings clean, dry and untouched. The first two weeks after surgery are usually spent with the patient’s foot elevated to help decrease swelling. Within the first month of surgery, the patient’s stitches/staples are removed. The patient is then placed into a cast, boot, or surgical shoe, and remains non-weight-bearing for another few weeks.

At the next appointment, the patient will receive foot X-rays to check on the healing of the first TMT joint fusion. So long as the bones are healing, patients are allowed to advance their weight bearing. Once the first TMT joint is fully healed, patients can wean out of their boot or shoe and return to their previous level of activity. Physical therapy may be recommended to improve foot and ankle strength and range of motion.

Some residual swelling and discomfort is normal up to a year after surgery. Most patients are able to return to normal activities with minimal pain and/or problems by four to six months after the surgery.

Frequently Asked Questions

By making the bones grow together, does that affect my ability to walk or run?
A successful Lapidus procedure should allow patients to walk or run with minimal problems or pain once they are fully recovered from the surgery.

Why do I need to be non-weight-bearing for so long?
Patients are asked to limit their weight bearing for several weeks in order to prevent movement between the first metatarsal and medial cuneiform bones that are trying to fuse together. If there is too much motion between the bones, it can take longer for them to heal. Typically, bones take a few months to heal, so patients must limit weight bearing during that time.

What if my bones do not heal together?
When bones do not heal together the condition is called a nonunion. Patients who are diabetic or smoke are at higher risk for having this problem. This can also happen if patients put too much weight on the foot before the bones have a chance to fuse together. The most common symptom of a nonunion is continued pain after surgery. X-rays can show broken plates or screws that suggest that there is still movement at the fused joint, which is a sign of poor healing. Most nonunions need further surgery to achieve healing. This can involve more orthopaedic hardware (plates and screws) and/or some form of bone graft to help the bones heal.

OrthoNeuro Physicians that perform this procedure:

  •  
    Dr. Nick Cheney, 2016 Recipient of the Recent Graduate Award from OUHCOM

    Nicholas A. Cheney, D.O.

    Orthopedic Surgeon

    Foot & Ankle Surgery

Source: Lapidus for Hallux Valgus (2016) Retrieved from http://www.aofas.org/footcaremd/treatments/Pages/Lapidus-for-Hallux-Valgus.aspx