Lapidus Procedure for Hallux Valgus (Bunion) Correction
Edited by Daniel Farber, MD
The Lapidus procedure is named after the surgeon who originally described it, Paul Lapidus, in the 1930s. This procedure is used to correct bunion (hallux valgus) deformity by correcting the position of the metatarsal bone in the midportion of the foot and fusing it in place.
There are different ways to perform this procedure but it involves an incision over the top part of the midfoot. The first tarsometatarsal joint (the joint above the joint that has the bump of the bunion) is exposed and the cartilage removed to prepare it for fusion. The correction of the bunion comes from re-aligning the 1st metatarsal bone to be nearly parallel to the 2nd metatarsal bone as well as correcting any deformity that comes from rotation of that bone. The fusion is then locked in place with screws, plates, staples or other devices according to how your surgeon prefers to do it. The procedure usually also involves an incision between the first and second toe to release any tissues that have become tight over time while the bunion was there. The surgeon may also make an incision over the bump itself on the inside part of the foot to remove any remaining bump.
The recovery time can vary from immediate weightbearing in a special boot to a period of 6 weeks of no weight on the foot depending upon how the surgery was done and how the surgeon prefers to treat their patients. Usually, after 6 weeks, patients can come out of the special boot if they have been weightbearing, or start weightbearing if they haven’t been allowed to yet. The foot usually swells after surgery so it can take 2-4 months to get back to a regular shoe and 6 months or more for the foot to be nearly normal. As with any bunion surgery, the toe joint can be stiff at first but that usually gets better with time and activity. Sometimes physical therapy is needed.
The surgical complications that can happen with a Lapidus procedure that can happen with any surgery include:
- Wound breakdown
- Non-union (the fusion of two bones that doesn’t heal)
- Deep Vein Thrombosis (DVT) (blood clot)
- Pulmonary Embolism (blood clot that goes to the lung and kills a person)
Complications that are specific to a Lapidus procedure include:
- Delayed healing or non-healing of the 1st TMT joint fusion. This may require a longer time of being off of the foot, use of a bone stimulator device, or even another surgery to help it heal.
- Injury to the local nerves that can result in loss of sensation (numbness) over the inside of the great toe or an irritating feeling (numbness or “pins and needles”) in the inside part of the foot. These problems usually get better over a few months to a year or more but sometimes they are permanent.
- The bunion deformity can come back, but it is thought that this type of bunion surgery has a lower rate of the deformity coming back than other procedures.
Edited October 11, 2019