A bunion (hallux valgus) is a common foot deformity where the big toe joint develops a painful, bony bump. This occurs when the first metatarsal shifts away from the other toes, causing the big toe to angle inward toward the second toe. A bunionectomy is the surgical procedure used to correct this misalignment and remove the bony prominence. The Lapidus bunionectomy is a specialized technique that addresses the root cause of the deformity by stabilizing the foundation of the foot.
Why the Lapidus Procedure is Selected
The Lapidus technique is chosen primarily for patients with moderate to severe bunions caused by an unstable foot structure. This instability is known as first metatarsal hypermobility, meaning the tarsometatarsal (TMT) joint connecting the first metatarsal to the midfoot has excessive movement. When this foundational joint is loose, the front of the foot spreads, allowing the bunion deformity to progress rapidly.
Traditional bunion surgeries, such as a Chevron or Austin osteotomy, involve cutting and repositioning the bone closer to the toe joint. While effective for milder deformities, these procedures often fail when the TMT joint is hypermobile because they do not address the unstable foundation. The loose TMT joint remains, which can lead to a recurrence of the bunion, forcing the metatarsal to drift back out of alignment.
The Lapidus procedure is the preferred solution for severe deformities, especially when the angle between the first and second metatarsal bones exceeds 15 degrees. By stabilizing the TMT joint, the Lapidus procedure offers a durable correction that reduces the risk of the bunion returning. It corrects the deformity in multiple planes—axial, sagittal, and coronal—providing comprehensive realignment of the forefoot.
The Surgical Process: Fusing the Tarsometatarsal Joint
The Lapidus procedure achieves permanent correction through arthrodesis, or surgical fusion, of the first tarsometatarsal (TMT) joint. This joint is located in the midfoot, further back than where most traditional bunion surgeries are performed. The surgery begins with an incision on the top-inside aspect of the foot to access the joint.
The surgeon removes the cartilage surfaces from the first metatarsal bone and the medial cuneiform bone that form the joint. This prepares the bone surfaces to grow together. Next, the first metatarsal is realigned to correct the bunion angle, simultaneously correcting the rotational and vertical position.
Once the metatarsal is in its proper position, the two bone surfaces are compressed and held rigid with specialized internal hardware. This fixation commonly involves screws or a combination of screws and a small metal plate spanning the fused joint. The hardware maintains alignment while the bones heal and fuse permanently, stabilizing the entire first ray of the foot.
Recovery Timeline and Return to Activity
Recovery from a Lapidus bunionectomy is longer than non-fusion procedures because it relies on bone healing. The initial phase involves a period of strict non-weight-bearing on the operated foot. Patients must remain completely off their foot for the first four to six weeks post-surgery, relying on crutches or a knee scooter for mobility.
During this initial timeframe, rest, elevation, and ice are encouraged to manage swelling and promote wound healing. At the two-week mark, sutures are removed, and the surgical site is inspected. The transition out of the non-weight-bearing phase begins after four to six weeks, provided X-rays confirm initial bone fusion is underway.
The patient then moves into a controlled weight-bearing phase, usually utilizing a removable walking boot. Physical therapy often begins around six to eight weeks after surgery to restore strength and range of motion. Most patients transition back into supportive, regular shoes between eight and ten weeks post-operation. Full bone fusion typically takes about 12 weeks, and a complete return to high-impact activities, such as running or jumping sports, requires three to six months.