What is the Lapidus procedure?

The Lapidus procedure was an operation to correct a deformity commonly called hallux valgus. The treatment involved joint arthrodesis, which involved the first metatarsal bone and one of the small bones in the middle foot called the medial cuneiform. The surgery usually involved removing cartilage on both bones, correcting the angular deformity, and using hardware in the form of screws and, in most patients, a small plate, to help the two bones grow together or join. The procedure may be used by your foot and ankle orthopedic surgeon when there is a bunion deformity with a huge angle or where there is increased mobility through the tarsometatarsal joint. Too much looseness or movement in the TMT joint is called hypermobility or instability. This occurs when the joint is too extended and the first metatarsal moves too far to one side. Then, simultaneously, the big toe should go in the opposite direction, and a bunion will form at that point.

The Lapidus operation aims to reverse hallux valgus due to the first TMT joint instability by anatomic fusion. Since the first TMT joint is fused, the first metatarsal will not find its new, abnormal position. This will allow the patient's first toe to orient them back to a more normal orientation, decreasing the bunion's recurrence.

Why would it be done?

Lapidus is done for 2 reasons:

Arthritis of the joint—Here, surgery is for pain induced by arthritis. Before surgery, a steroid injection would have been a trial. If it fails to relieve the pain adequately, then surgery is considered.

This is commonly done during bunion surgery when the joint is hypermobile- that is, very unstable. In that scenario the aim is to stabilize the correction of the movement in the big toe and prevent recurrence.

What anesthesia is provided for the Lapidus procedure?

The surgery can be performed with local, regional, spinal, or general anesthesia. Lapidus procedures are generally outpatient procedures, and therefore, patients can be discharged on the day of surgery.

This most common anesthesia technique applied to Lapidus surgery is a combination of local and regional block with monitored anesthesia care, which means that the foot will be numbed using an anesthetic, and an anesthesiologist will offer intravenous medications to relax and give sedation, also often referred to as "twilight". A patient will neither experience nor remember her surgery.

What happens after the Lapidus procedure?

You will need to rest with your leg elevated for 2 weeks following the operation. This is meant to decrease swelling and enable the wounds to heal. Swelling of much will occur following the operation. When leaving the hospital, you can walk around on crutches. Avoid weight bearing on the foot. The foot should always be dry.

Your plaster will be changed and your wounds assessed around 2-3 weeks following the procedure. There will be another appointment a few weeks later, at which time the plaster will be changed, x-rays taken, and you may be able to transfer into a removable surgical boot and begin transferring some of your weight onto the foot when wearing the boot. Your surgical team will advise you concerning your weight-bearing status. You will see the physiotherapist to teach you how to walk with the boot.

Further X-rays will be arranged a few weeks later to check on the joint fusion. When good fusion is seen, you can start to wear a normal supportive shoe.

There will be some swelling for several months, so to maximize the result, you should keep elevating your foot at regular intervals and pacing your activities sensibly as you recover from the surgery.

What are the risks of the Lapidus procedure?

General risks apply to all surgeries; bunion surgery and any form of anesthesia carry their own risks, and complications can indeed arise. Patients are not a cause or a fault, and neither is the surgeon, but they need to be informed of potential risks.

Some possible complications of bunion surgery include but are not limited to infection, pain which can be temporary or permanent, swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing causing delayed union, nonunion, malunion, nerve injury, disability, recurrence, hallux varus, metatarsalgia, unsightly scar, stiffness, shortened big toe during bunion surgery, weakness in big toe, toe drift after bunion surgery, hardware problems, need for revisional surgery, and/or catastrophic loss.

How long does a Lapidus procedure recovery take?

For healthy patients, the expected time for bones to mend after the Lapidus procedure is six weeks. The majority of patients are able to return to their normal activities, both in shoes and out of them, between six weeks and three months after the Lapidus surgery. Conditions that prolong healing are age, smoking, and and poor nutrition, among many other medical problems.

Can I run after Lapidus?

Having been operated upon successfully with the Lapidus procedure, you should be able to walk or run without too many problems or pain once you have fully recovered.

Do I have to have a plaster after the operation?

You will need a plaster from your toes to your knee until the joint has fused, which usually takes 8-12 weeks. However, you may be suitable to wear a removable boot rather than a plaster 8 weeks after your operation.

Why Tender Palm Super-Speciality Hospital for Lapidus Procedure?

Tender Palm Hospital, owned by doctors, is renowned for attracting the most skilled professionals in the country. With the finest Orthopedic surgeons, specialized in Lapidus Procedure. Tender Palm stands out as the premier orthopedic hospital in Lucknow, India. Boasting cutting-edge infrastructure and advanced technology, Tender Palm ensures top-notch medical care for its patients.