Lapidus Fusion
1st Metatarsal-Cuneiform Joint Fusion

Procedure

1st Metatarsocuneiform Joint Fusion.

Aims of surgery

To reduce pain and deformity in larger or unstable bunions.
To straighten the big toe.

Advantages of this operation

It helps to stabilise the foot and allows correction of larger deformities.
It addresses arthritic and painful 1st Metatarsal/ cuneiform joints with bunion deformities.

Specific risks of this operation

Joint stiffness.
Arthritis in other joints.
Transfer of pressure to the ball of foot. Recurrence.
Nerve/tendon/blood vessel damage. Delayed/Non-union of bone (bone does not knit together).
Fixation problems (with the screws/plates/pins). Elevation of the 1st metatarsal.
Shortening of the big toe.
Further surgery.
Deep Vein Thrombosis/Pulmonary Embolism.

Operation time

Usually about 60–90 minutes. stitches (where possible).

Incision placement/stitches

Usually on the side of the foot and with absorbable stitches (where possible).

Procedure

The bony surfaces either side of the rst metatarso- cuneiform joint (joint at the base of the rst metatarsal) are cut away to allow correction. The raw bone surfaces are then held together whilst they fuse (heal together). In addition an akin or closing wedge osteotomy/bone cut of the big toe may be required.

Fixation

Internal fixation (bone screws, plates or wires) are usually used.
You will not normally notice these and they do not usually need to be removed (<20%).

Will I have plaster?

Yes, usually for about 4 weeks. You will require crutches for about 4 weeks, then a cam walker for further 2–4 weeks.

Is this a day procedure?

Yes, you can usually go home the same day (you will usually be admitted for half a day).

Estimated time off work

Non-manual work approximately 4 weeks.
Manual work approximately 8–10 weeks.

Alternative treatments

Manage your symptoms by altering activity levels, using painkillers and anti-inflammatories, changing footwear (including bespoke), joint injection therapy and using an insole or orthotic foot support (the use of insoles/orthoses or toe splints has not been shown to correct toe deformity).

More information

Speak with your consultant.

The surgery is usually undertaken with local anaesthetic in conjunction with sedation or general anaesthesia.

The operation takes about 90 minutes, although you will be in the day surgery unit for longer. You must have a competent adult at home for the rst day and night after surgery. This allows us to be sure you will be safe for the rst night. Your operated leg will be non weight-bearing in a cast for approximately 4–6 weeks. It is therefore very important that you have people to look after you and any dependants, such as children, elderly or disabled relatives, during this time.

Post-Operative Care

First 2–4 days after surgery

This is the time you are likely to have the most pain, but you will be given painkillers to help. You must rest completely for 2–4 days.
You will have a below knee cast and cannot put weight on the operated foot.
You will be able to stand and take weight on your non-operated foot after the operation, but you must rest with your feet up, as much as possible.
You should restrict your walking to going to the bathroom. When getting about, use your crutches in the way you will have been shown.
You can get about a little more after 3 days.

1 week after surgery

You will need to attend for your foot to be checked and, if necessary, redressed/recasted.

Between 4–6 weeks after surgery

The cast will be removed if all is proceeding well and you will be allowed to start walking in a cam walker.

Between 8–10 weeks after surgery

If all has gone well you will be able to start wearing a good lace-up shoe/trainer.
The foot will still be swollen and twinges of discomfort are not uncommon at this time due to your increasing activity. Your leg will feel naturally weak to start with as it has been in a cast.
You will be instructed regarding rehabilitation exercises or you may be referred to a physiotherapist.
You may return to non-manual work but may need longer if you have an active job.
You may return to driving if you can perform an emergency stop. You must check with your insurance company and Mr. Cichero before driving again.

Between 12–16 weeks after surgery

The foot should continue to improve and begin to feel normal again.
There will be less swelling.
Sport can be considered depending on your recovery.

6 months after surgery

You will have the final review between 3–6 months following surgery.
The swelling should now be slight and you should be getting the full bene t of the surgery.

12 months after surgery