Lapidus Procedure

What is the Lapidus procedure?

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Top and side views of the first metatarsal and medial cuneiform bones (circled in red) that make up the first TMT joint.




 Lapidus procedure is a surgical treatment for a bunion deformity​, also know as hallux valgus. The procedure involves fusing the joint between the first metatarsal and one of the small bones in your midfoot, the medial cuneiform. 

Your surgeon performs a fusion by removing the cartilage surfaces from both bones, correcting the angular deformity, then placing hardware (screws and often a small plate) to allow the two bones to grow together, or fuse. This surgery is often selected when the bunion deformity has a very large angle, or when there is increased mobility through the tarsometatarsal (TMT) joint.  When this joint has too much looseness or movement, the condition is known as hypermobility or instability. When this joint becomes hypermobile, the first metatarsal moves too far in one direction and the big toe compensates by moving too much in the other direction. When this happens, a bunion can develop.​
 

What is the goal of the Lapidus procedure?

The goal of the Lapidus procedure is to surgically treat bunions caused by first TMT joint hypermobility. When the first TMT joint is fused, the first metatarsal will not move abnormally. This will allow the big toe to stay straight and decrease the risk of the bunion from coming back.  

What signs indicate you might need surgery?

  1. Pain at the bunion. Patients with a painful bunion have a bump on the inner part of the big toe. Typically this bump causes pain when it rubs the inside of a shoe.
  2. Pain and/or hypermobility at the first TMT joint.
  3. Difficulties wearing shoes. When patients have a severe enough bunion due to first TMT joint hypermobility, the foot can be so wide that it is difficult to find shoes that fit.
  4. Pain that does not improve with nonsurgical treatments such as wearing shoes with a wide toe box. 
 

Details of Procedure

Typically the Lapidus procedure is outpatient surgery. The patient arrives 1-2 hours before the scheduled start of the procedure and goes home the same day.

Anesthesia may be general or sedation. A nerve block may be done either by the surgeon or the anesthesiologist. 
 

Surgical Technique

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X-ray showing two screws placed across the first TMT joint in opposite directions.  Note that the joint line is not visible​, which means that the joint has fused.​
Lapidus procedure is often one part of bunion correction surgery. Once the large bony prominence near the big toe is removed, attention is turned to the TMT joint. 

After the cartilage surfaces of each bone are removed, the alignment is corrected and the bones are compressed together with hardware. This may be screws or a combination of a plate with screws along the side of the joint.  

Once the Lapidus is completed, additional procedures may be necessary to complete the correction of the bunion deformity. 
 

What happens after surgery?

Patients are typically immobilized in a splint or boot for the first two weeks after surgery to allow for the incisions to heal. They are often restricted from putting full weight on the foot. 

Around six weeks after surgery, patients are typically allowed to progress to full weightbearing in either a boot or post op shoe, then slowly transition to regular shoes 1-2 weeks later.

Some residual swelling and discomfort is normal up to a year after surgery. Most patients are able to return to normal activities with minimal pain and/or problems by 4-6 months after the surgery. 
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Frequently Asked Questions

By making the bones grow together, does that affect my ability to walk or run?
A successful Lapidus procedure should allow patients to walk or run with minimal problems or pain once they are fully recovered from the surgery.

Why do I need to be non-weight-bearing for so long?
Patients are asked to limit their weight bearing for several weeks in order to prevent movement between the first metatarsal and medial cuneiform bones that are trying to fuse together. If there is too much motion between the bones, it can take longer for them to heal. Typically, bones take 6-8 weeks to heal, so patients must limit weight bearing during that time.

What if my bones do not heal together?
When bones do not heal together the condition is called a nonunion. Patients who are diabetic or smoke are at higher risk for having this problem. This can also happen if patients put too much weight on the foot before the bones have a chance to fuse together. The most common symptom of a nonunion is continued pain after surgery. X-rays may show broken plates or screws, twhich suggests there is still movement at the fused joint. Most nonunions need further surgery to achieve healing. This can involve more orthopaedic hardware (plates and screws) and/or some form of bone graft to help the bones heal.

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area. ​​