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Saturday, April 9, 2022

Problems with Lapidus Bunionectomy

Dear Dr. Blake,
     I had a Lapidus bunionectomy 2 years ago that is coming back. Will your conservative treatments help this? I have 2 pairs of new orthotics. One pair has a high dome in the mid arch to help with metatarsalgia, specifically 2nd toe pain. The other pair has a higher dome in the medial arch to correct over pronation and PTTD. I just started wearing these hoping to stop the bunion from coming back. Any advice on which pair is better? I have redness where the bunion is coming back and the big toe is starting to drift towards the 2nd toe. The hardware is painful and I would like it removed. Any advice would be appreciated. Thank you. 

Dr Blake's comment: First of all, it is really unusual for a Lapidus to cause a recurrence of a bunion this early post operative. If we share further emails, even a year from now, always remind me of this post on 4/9/22. As you walk, the forces of the ground will always push the big toe towards the second. This is more or less depends on other aspects of your foot biomechanics, shoe gear, activity level, and activities done. Did you have the Lapidus done to help with PTTD? Or were you just having bunion pain? How old are you may I ask? Why is the hardware painful, or when is it painful? Since I do not perform this surgery, you need to ask the surgeon, but most hardware can come out after 6 months post surgery for sure. You need to always wear toe separators to keep the big toe from drifting towards the 2nd toe. A Lapidus immobilizes a joint or two in the arch, so there is more stress at the bunion joint and the joint next in line closest to the ankle. The orthotic devices just have to make you stable, and you may find that the right and left sides feel the better with orthotic devices from different pairs. Are these full length orthotic devices, or ones that stop traditionally behind the metatarsal heads? There are pros and cons to each. Give me some feedback, and I will place any more information on this same post. Rich 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.