Lapidus Bunionectomy
The Lapidus bunionectomy is performed on those deformities which are hyper mobile or severe enough to require a fusion of the first metatarsal-cuneiform joint. The joint between these two bones is removed and the bones are held together with fixation turning two crooked bones into one straight bone.
A bunion patient has a first metatarsal which is pointing inward and creating a bump on the inner part of the foot, just proximal to the big toe. The problem is the first metatarsal is deviating inward (medially) and hence the big toe (hallux) is pointing outward (laterally). Depending on the severity of the deformity, sometimes the hallux will overlap or under lap the second toe. Bunion pain is different for everyone, but it likely includes discomfort at the "bump", big toe pain, achiness of the arch and generalized discomfort of the smaller toes.
We will perform your surgery at a hospital or surgi-center and, depending on your health and age; you may be required to have preoperative blood work and testing. Generally the surgery is performed on an outpatient basis, meaning you will be able to go home the same day as your surgery. An anesthesiologist will meet with you before your surgery and review your health history to determine the best method of anesthesia for your particular case. Many times they will decide to use MAC anesthesia for this type surgery. This is a mild sedative which allows us to inject the local anesthetic into the surgical site without you feeling pain. Only after we have determined the area to be anesthetized (numb) will we begin surgery.
Through an incision on the top of your foot, the first metatarsal-cuneiform joint is removed in a "pie-wedge" fashion. This angled bone cut allows for the two bones to rest end to end in a straight line so that your bunion deformity is no longer present. The two ends of bone are held together with small screws which allow the bone to "knit" itself from two bones into one solid bone. Your foot and leg is placed into a cast so as to protect the surgical site and allow the bone to heal. During your recovery you will not be permitted to walk on the foot and will need to use crutches, walker and/or wheelchair to get around until the bones have healed. Each doctor has a different time frame for bone healing, but it averages between 2-6 weeks.