Lapidus Procedure

The Lapidus procedure decreases the movement of the first Tarsal-MetaTarsal (TMT) joint and straightens out the first metatarsal and toe. This enables a quick recovery for bunions and other major deformities caused by the first TMT joint hypermobility.

This surgery is often selected when your bunion deformity has a very large angle, or when there is increased mobility through your tarsometatarsal (TMT) joint. When this joint is too loose causing too much movement, the condition is known as hypermobility or instability. When this joint becomes hypermobile, the first metatarsal moves too far in one direction and the big toe compensates by moving too much in the other direction. When this happens, a bunion can develop.

The looseness of your joint and its hypermobility may lead to the pain experienced on the ball of the foot as the first metatarsal floats up, thereby allowing the excessive weight of your body to go to adjacent metatarsals (commonly the second and the third).

In such cases, the metatarsal-tarsus joint is fused to provide lasting stability.

Conditions

Your doctor may recommend the Lapidus procedure if an osteotomy alone will not provide an adequate correction and alignment due to a severe deformity, instability of the first ray, or a loose metatarsal-tarsal joint (located in the mid-foot).

Signs that you may need a Lapidus procedure:

• Pain at the bunion. Your painful bunion has a bump on the inner part of the big toe. Typically this bump causes pain when it rubs the inside of a shoe.

• Pain and/or hypermobility at the first TMT joint.
• Pain that does not improve with nonsurgical treatments such as wearing shoes with a wide toe box

• Difficulties wearing shoes. When patients have a severe enough bunion due to first

TMT joint hypermobility, the foot can be so wide that it is difficult to find shoes that fit.

Surgery

The Lapidus procedure is often a quick correction surgery. The patient arrives 1-2 hours before the scheduled start of the procedure and goes home the same day.

• You will receive anesthesia or another sedative.
• Your doctor will perform a fusion by removing your cartilage surfaces from both bones, correcting the angular deformity.
• Your doctor will then place the hardware (screws and often a small plate) to allow the two bones to grow together, or fuse.
• Once the large bony prominence near the big toe is removed, attention is turned to the TMT joint.
• Once the Lapidus is completed, additional procedures may be necessary to complete the correction of the bunion deformity.

Rehabilitation

• You will be immobilized in a splint or boot for the first two weeks after surgery to allow for the incisions to heal.
• You will be restricted from putting full weight on the foot.
• Around six weeks after surgery, you will be able to bear your full weight and progress to either a boot or post-op shoe, then slowly transition to regular shoes 1-2 weeks later.
• 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 4-6 months after the surgery.