Lapidus Bunionectomy

The Lapidus bunionectomy, a procedure where the bunion is corrected by relocating the entire 1st metatarsal bone back to its proper (native) position in the foot.

The basis behind the Lapidus procedure is to treat the bunion at the apex (origin) of the problem. This means correcting the problem that produced the bunion in the first place.

If you were an engineer designed to straighten out the leaning tower of pisa – where on the tower would you recommend that the repair work be performed? You wouldn’t cut the top part of the tower, rather you would fix the tower at the bottom. Similarly, the Lapidus procedure is aimed at correcting the bunion (or mal-aligned 1st metatarsal) in a similar fashion. While bunions and metatarsals are not buildings, one can get a better understanding of the concepts of certain surgical bunion corrections.

The Lapidus procedure often entails 3 main parts:

  1. Removing any prominent bone (the bump) on the inside of the foot
  2. Releasing a tight tendon that pulls the big toe outward toward the 2nd toe
  3. Resecting a joint in the midfoot – needed to realign the 1st metatarsal in proper position. This is non-essential joint of the midfoot. done at the base (bottom) of the 1st metatarsal.

When the bone is repositioned, the bone ends are placed directly next to each other allowing the bones to mend of fuse together.

Surgical bone screws are needed to hold the bone in its corrected position until the bones mend or fuse – which typically takes 6 weeks.

Below you see photographs of feet that have had the Lapidus Bunionectomy.

My doctor tells me I have hypermobility, is this something I should worry about?

Hypermobility is a condition where the midfoot is too mobile, often causing the bunion altogether. This hypermobility is considered by some to be abnormal. This extra motion is also may be responsible for arch collapse as well as pain on the ball of your foot just behind the 2nd toe. (See diagram). It must be understood that hypermobility by itself may not be a problem. When hypermobility occurs in the presence of pathologic conditions such as bunion, it is then considered, by some, to be a contributing problem.

How is hypermobility treated?

For starters, hypermobility can be managed conservatively with orthotics – see Non-surgical treatment. The 1st metatarsocuneiform joint is often responsible for a predominance of this hypermobility, but several midfoot joints contribute. It is the 1st metatarsocuneiform joint that is also considered to contribute to the bunion occurrence in the first place.

It is generally thought that hypermobility is corrected or managed when the big toe and the 1st metatarsal are properly realigned after bunion surgery. Depending on the size of the bunion and several other factors, this extra motion may be surgically treated with a variety of bunion correction procedures. In particular, the Lapidus procedure has been associated with treating hypermobility simply because it removes the 1st metatrsocuneiform joint which is thought to be responsible for this excess motion, in addition to correcting the bunion as well.

Disclaimer: All information on SurgeryBunion.com is informational. It does not constitute medical advice. For medical advice consult a licensed physician.