Bunions (hallux valgus), one of the most common sources of foot pain, occur when the big toe angles in toward the other toes, causing enlargement of the metatarsophalangeal joint. As the big toe bends toward the other toes, the resulting lump on the side of the foot becomes larger and more painful. Restrictive shoes, arthritis and constant pressure inside the joint cause pain for bunion sufferers and — when conservative care fails — may necessitate corrective surgery.
Lapidus bunionectomy is a procedure that uses the latest surgical techniques and equipment to correct the underlying cause of the bunion rather than just relieve its symptoms.
Conservative care
Bunions cannot improve on their own and the deformity will gradually worsen over time. The first step to treating bunions is conservative therapy that aims to relieve pressure on the bunion and slow its inevitable progression. This can include comfortable or customized footwear, foot orthotics and specific exercises to stretch the joint and improve its range of motion.
Traditional bunion surgery
When conservative treatment fails to relieve pain, bunion surgery may be recommended. Indications for bunion surgery include foot pain that limits activity, chronic inflammation and a significant deformity of the big toe. The choice of surgical procedures depends on bone involvement, the degree of deformity and any other contributing factors that can increase swelling or pain.
Traditional bunion surgeries may include:
Bumpectomy — the lump on the side of the big toe is surgically removed
Osteotomy — a segment of the metatarsal is removed from the big toe and screws are used to secure the realigned metatarsal to the metatarsophalangeal joint
Joint fusion — damaged joint is removed and replaced with a plastic joint spacer
In most moderate cases, bunion surgery will help relieve pain and improve the alignment of the toes. Over time, however, bunions can recur, indicating a need to take a closer look at the cause of the deformity.
Lapidus bunionectomy
The goal of Lapidus bunionectomy is to move the metatarsal bone back to its original place on the foot. The first metatarsal, which runs along the side of the big toe, is often unstable at its base joint, called the metatarsocuneiform joint. If a patient has an underlying laxity of the metatarsocuneiform joint, a surgical procedure such as an osteotomy — which aligns the two joints but does not stabilize the metatarsocunieform joint — may result in a recurrence. The instability of the joint will gradually allow the joint to loosen over time, leading to more bunions.
The lapidus procedure realigns the metatarsal joint at the midfoot. Surgical screws hold the joints together, allowing for fusion of the metatarsal to the cuneiform joint, resulting in permanent correction of the metatarsal position. The first metatarsal fuses to the midfoot, preventing the laxity of the joints that often causes bunions to return. The increased stability in the arch also results in improved foot alignment and function.
Results of more than 400 lapidus style bunion corrections performed at the Foot and Ankle Institute over the course of four years have resulted in no bunion recurrence, nor any other complications.
The lapidus procedure is performed under local anesthesia with mild sedation in an outpatient setting. After surgery, patients should not put weight on their foot for six weeks to allow proper joint fusion. Physical therapy may be helpful for post-operative strengthening and joint mobilization. Patients can expect to return to their normal activities after three months.
Contact Information
Bob Baravarian, DPM
Assistant Clinical Professor
UCLA Division of Podiatry
Co-director, The Foot and Ankle Institute
(310) 828-0011
http://www.footankleinstitute.com
Gary Briskin, DPM
Assistant Clinical Professor
UCLA Division of Podiatry
Co-director, The Foot and Ankle Institute
David Soomekh, DPM
The Foot and Ankle Institute
Justin Franson, DPM
The Foot and Ankle Institute
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