What is Lapidus Bunionectomy?
A lapidus bunionectomy is a surgical procedure to correct a foot condition called a bunion.
A bunion, also known as hallux valgus, is a bony prominence (bump) at the base of the big toe, which often results in pain, redness, and rubbing of the toe against the footwear. With this condition, the 1st metatarsal bone of the big toe abnormally angles outward towards the other foot from its joint in the midfoot. The condition is caused by excess bone growth and/or misalignment of the foot and toe bones, most commonly as a result of wearing poorly fitting shoes that are too tight, narrow, or high-heeled. Other causes include family history, genetics, arthritis, neuromuscular conditions, and connective tissue disorders.
Lapidus bunionectomy involves removing the bony prominence and restoring the proper alignment/ position of the big toe joint. During the surgery, the joint between the 1st metatarsal bone and one of the small bones in the midfoot called the medial cuneiform is fused. The surgery includes removing the cartilage surfaces from both bones, correcting the angular deformity, and then placing hardware (plate and screws) to enable the two bones to fuse or grow together.
Indications for Lapidus Bunionectomy
Your surgeon may recommend lapidus bunionectomy if bunion symptoms continue to persist despite using conservative treatment. These symptoms may include:
- Significant foot pain that limits your activities of daily living (ADL)
- Chronic inflammation and swelling of the big toe that does not improve with medication or rest
- Hypermobility and instability of the 1st metatarsal
- Toe stiffness or the inability to straighten or bend the big toe
- Failure to obtain pain relief with changes in footwear
- Unsuccessful treatment of pain with NSAIDs (nonsteroidal anti-inflammatory drugs) or other conservative treatment modalities
Preparation for Lapidus Bunionectomy
Preparation for lapidus bunionectomy may involve the following steps:
- A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
- You may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the surgery.
- You should inform your doctor if you have allergies to medications, anesthesia, or latex.
- You should also inform of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to refrain from certain medications such as blood thinners, anti-inflammatories, or supplements for a week or two prior to the surgery.
- You should refrain from alcohol or tobacco at least a few days before surgery and several weeks after, as it can hinder the healing process.
- You should arrange for a family member or a friend to drive you home after the surgery.
- A signed informed consent will be obtained from you after the surgery has been explained in detail.
Procedure for Lapidus Bunionectomy
Lapidus bunionectomy surgery is typically an outpatient surgery, meaning you can go home the same day. Surgery is usually performed under general anesthesia so you will be fully asleep or a nerve block is used.
In general, lapidus bunionectomy surgery will involve the following steps:
- You will be placed in a supine (face-up) position on the procedure table with your foot held in an optimal position to facilitate surgery.
- Your surgeon will make an incision along the top of the inner side of the foot to access the bunion and the misaligned bones of the big toe and foot. These include the proximal phalanx, the 1st metatarsal, and the cuneiform.
- Your surgeon will then trim the excess bone growth from the end of the metatarsal, removing the large bump on the inner side of the foot.
- If required, your surgeon may also cut a tendon in the foot that is pulling the toe out of alignment.
- Next, your surgeon will focus on repositioning the metatarsal bone against the cuneiform bone, which is situated at the point where the toe meets the foot.
- Your surgeon will use fixation devices such as pins or screws to attach these bones together. During the healing process, these bones will fuse together and restore function in the foot.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after lapidus bunionectomy surgery may include the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed to address these.
- You are advised to keep your foot elevated as much as possible while resting to reduce swelling and pain.
- Your big toe will be secured with a dressing and placed in a cast or surgical boot for 8 to 12 weeks to protect the repair and facilitate healing.
- You will be encouraged to get up and walk as frequently as possible to prevent blood clot formation. A walker or cane may be provided to facilitate safe walking, along with instructions on restricted weight-bearing.
- Instructions on surgical site care and bathing will be provided to keep the surgical site clean and dry.
- Refrain from strenuous activities such as running for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol will be designed once you are off assistive devices to help strengthen foot muscles and optimize foot function.
- Most patients are able to resume their normal activities in a month or two after surgery; however, returning to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- Periodic follow-up appointments will be scheduled to monitor your progress.
Risks and Complications
Lapidus bunionectomy surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Pain
- Swelling
- Hematoma (blood pooling)
- Nerve injury
- Joint stiffness
- Infection
- Numbness
- Weakness
- Bleeding
- Poor bone healing
- Hardware problems
- Thromboembolism or blood clots
