Lapidus Procedure for Bunions: Normal Results (what are your odds) for the Consumer

https://www.jfas.org/article/S1067-2516(22)00118-1/fulltext?rss=yes

Summary of Results:

Lapidus is a very common bunion surgery and the results of this study following patients for 2 years showed the odds. One of the differences from standard Lapidus procedures that this study tried to prove was that they could allow their patients to walk much quicker than standard 8-12 weeks of non-weight bearing, therefore walking in normal shoes on average 45 days post surgery!! This is huge!!

The results are pretty standard for operations at the foot:

1/117 early re-occurence of the bunion (typically want to get 15 years out of this procedure)

11/117 hardware was irritative (considered a complication)

5/117 other complication including 1 non-union

In total, 7/117 were re-operated on to fix issue within the first 2 years post Lapidus

If you match up the results I tell my patients before they get surgery, I think this study is slightly better.

I tell my patients, that 85% of them will be happy they had the bunion surgery (really good from our Podiatry perspective). Of that 85%, 50% of those patients will say excellent results and 35% will say good results from the surgery (good means that they are not perfect, but they are still happy that they went through it). The other 15% get fair to poor results (with this study around 10% which is close). 1-2% of patients are poor due to an infection, non-union, early bunion return, etc. 13% are fair due to some of the issues brought up (hardware irritation, pain more than they like, entrapped nerve, negative effect somewhere else, etc). Poor results tend to be re-operated on to fix what went wrong, and fair results about 50% have a re-operation (7% overall re-operation) and the same number just want to live with the issue. This 7% is almost exactly what the study showed for re-operartion 7/117 which is normal Podiatry surgery odds. So, in summary, I think this study showed that Lapidus patients (fusion across the metatarsal tarsal area) can walk earlier then the standard recommendation since the complication rate does not go above the standard 15% at all. 

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