A bunion, also known as hallux valgus, is a bony bump that forms on the joint at the base of the big toe. This occurs when the bones in the front part of the foot shift out of their normal alignment, causing the big toe to lean toward the smaller toes. The joint at the base of the big toe then protrudes, creating the visible bump. Over time, this deformity can progress, leading to pain, swelling, and difficulty wearing shoes.
While conservative measures like wider shoes, padding, or orthotics can help manage symptoms, they do not correct the underlying deformity. When pain becomes severe, interferes with daily activities, or the deformity worsens despite non-surgical treatments, surgical intervention may be considered. Surgery aims to relieve pain, correct the alignment of the toe, and improve overall foot function.
Understanding the Lapidus Bunionectomy
The Lapidus bunionectomy is a surgical procedure designed to correct a bunion deformity by addressing its root cause: instability in the midfoot. Unlike some other bunion surgeries that primarily focus on correcting the deformity closer to the big toe joint, the Lapidus procedure targets the first tarsometatarsal (TMT) joint. This joint connects the first metatarsal bone, which leads to the big toe, with a bone in the midfoot called the medial cuneiform.
The core of the Lapidus bunionectomy involves fusing this first TMT joint. Fusion involves preparing joint surfaces and holding bones together with hardware (e.g., plates, screws) until they grow into one solid bone. This fusion stabilizes the base of the first metatarsal, preventing it from drifting outward, which is a primary reason for bunion formation and recurrence. This approach is particularly beneficial for bunions associated with hypermobility, where the first TMT joint is unusually flexible, or for larger, more complex bunion deformities. By stabilizing the foundation of the foot’s arch, the Lapidus procedure provides lasting correction and reduces recurrence.
The Surgical Process
A Lapidus bunionectomy begins with an incision made on the top of the foot, near the big toe and extending towards the midfoot. This incision allows the surgeon to access the underlying bones and joints. The surgeon then carefully removes any excess bony prominence, often referred to as the “bunion bump,” from the head of the first metatarsal.
The surgeon prepares the surfaces of the first tarsometatarsal joint by removing cartilage, which encourages bone fusion. Once the joint surfaces are ready, the surgeon realigns the first metatarsal bone to correct the angular deformity that causes the bunion. The realigned bones are then secured in their new position using specialized surgical hardware, which provides stability while the bones heal and fuse.
Finally, the soft tissues around the joint, including tendons and ligaments, are adjusted to maintain the corrected alignment. The incision is then closed with sutures. The entire procedure takes about 60 to 90 minutes to complete.
Post-Operative Care and Recovery
Following a Lapidus bunionectomy, immediate post-operative care focuses on managing pain and protecting the surgical site. Patients experience some pain, which can be managed with prescribed pain medication. Elevation of the foot above heart level and regular application of ice packs are important to reduce swelling and discomfort during the initial recovery phase.
The foot is immobilized in a cast or surgical boot immediately after surgery to protect the fusion site and maintain the corrected alignment. Weight-bearing restrictions are significant in the first few weeks, as the fused joint needs time to heal. Patients are advised to remain non-weight-bearing for six to eight weeks, using crutches or a knee scooter for mobility. Gradual progression to partial weight-bearing begins after this period, often in a walking boot.
Physical therapy starts several weeks post-surgery, after initial healing. Therapy sessions focus on restoring range of motion to the big toe and ankle, strengthening the foot and ankle muscles, and improving gait. Adherence to a structured physical therapy program is important for regaining strength and function. The overall recovery timeline for a Lapidus bunionectomy extends over several months, with significant improvement within three to six months.
Life After Lapidus Bunionectomy
Life after a Lapidus bunionectomy involves a gradual return to normal activities as the foot continues to heal and strengthen. Most individuals can transition back into regular shoes and resume light activities, such as walking, around three to four months post-surgery. Full recovery, including strenuous activities like running or sports, can take six months to a year.
Footwear recommendations after the procedure include shoes with a wider toe box and adequate support to comfortably accommodate the foot and prevent irritation. The goal of the Lapidus bunionectomy is to provide lasting relief from bunion symptoms and improve foot mechanics. Due to the fusion of the tarsometatarsal joint, the recurrence rate of the bunion deformity is low compared to some other bunion correction techniques. This procedure offers a stable and enduring correction, providing long-term comfort and improved foot function.