What is the Lapidus procedure?
Hallux valgus is a multiplanar deformity in the foot. Treating this deformity starts with conservative treatments such as orthotics, padding, shoe gear changes, injections and sometimes physical therapy. When a hallux valgus (commonly referred to as a bunion) does not improve well with these conservative treatments, surgery may be discussed as an option for care with you. Bunion surgery is alway elective (meaning it isn't a life or death situation) which means that you never HAVE to have bunion surgery. If you are limited due to pain or shoegear, you may elect to have surgery to correct the bunion.
One procedure that has been used for many years is now growing popularity. The procedure is called a Lapidus procedure. As with any procedure, it's name was derived by the doctor who first described it in literature. This procedure involves fusing the joint in the middle of the arch of the foot called the 1st metatarsal-cuneiform joint. This joint does not typically have a lot of motion, but the motion that does occur here can be excessive or abnormal. In addition, most bunion deformities derive from the midfoot area rather than closer to the big toe joint. When fusing the joint at this level, there is a great lever arm to work with and correct the prominence that is noted at the big toe joint. In addition, it has the potential to allow for rotation of the metatarsal (the bone behind the big toe) which corrects for the deformity in 1 more plane than traditional bunionectomy procedures allows.
The Lapidus procedure when done and healed correctly has the potential to reduce recurrence of the deformity more than some other bunion procedures. It is, however, not a procedure for everyone. In mild bunion deformities and in patients that are at risk of having difficulty healing after surgery, more traditional bunionectomy procedures are still indicated. Because the Lapidus procedure is more involved, the post-operative course is also different. Where most bunionectomy procedures allow a patient to walk on their heel after surgery, it is recommended that patients who undergo the Lapidus procedure do not bear weight on their surgical foot for 2 weeks, sometimes more. This is important to consider when discussing surgery, especially if you are considering surgery for your right foot. Some of the most difficult considerations pre-operatively is how you will get from place to place (driving) and how long you will need to be out of work (do you work a desk job or on your feet?).
If you are about to undergo bunion surgery, your surgeon will let you know what they feel has the best likelihood to safely correct your bunion and prevent it from recurring. Always ask whatever questions you have - there are no stupid questions and often those questions you are afraid to ask are the most important.