Lapiplasty: Advanced Technique in Bunion Surgery

bunion surgery

Are you suffering from a painful bump along the inside aspect of your big toe joint?  In short, does it make exercise, shoe wear, and other daily activities difficult?  You may have developed a painful bunion.  Let’s discuss what a bunion is, how it is formed, and what can be done about one.  We will also introduce Lapiplasty: advanced technique in bunion surgery!

What is a Bunion exactly?

Bunions, or hallux abducto valgus deformity, is a common deformity of the foot that causes many to suffer from chronic foot pain.  A bunion can form from a multitude of reasons.  Usually, they form in part to genetic predisposition, flattened arches, overpronation, or generalized foot instability such as ligamentous laxity. Additionally, poorly fitting shoes or repetitive foot stress may cause a bunion.  Conservative means of managing a painful bunion would be to wear wider fitting, better-accommodating shoes or use padding, strapping, and orthotics. While these modalities may provide temporary relief for many patients, nothing can reverse the deformity and restore normal anatomy.  That will require surgical correction.

Bunion deformity. Notice the angle between the big toe and the metatarsal behind it.
Bunion after Lapiplasty. The bunion has been correct, and the big toe is straight

 

 

 

 

 

 

 

 

 

 

 

Bunion Surgery

Bunion surgery has existed in the medical literature for over a hundred years.  And over a hundred different procedures have been tried, all searching for the best way to correct this deformity. Procedure choice is typically determined based upon several factors.  These may include:

  1. Patient expectations
  2. Desired activity level after surgery
  3. Bone mineral density
  4. Joint stability
  5. The ability for downtime following surgery
  6. Overall severity of the bunion

This has typically resulted in two widely used procedures:

    1. Distal Metatarsal Osteotomy – correction made at the level of the big toe joint; and
    2. Proximal Metatarsal Osteotomy, or Tarsal-Metatarsal Joint Fusion – corrections directed more towards the level of the mid-foot.

Customarily, a procedure is performed at the level of the big toe joint for mild/moderate bunions.  However, cases with greater severity may require the proximal procedure.

Research

Despite years of research and many different approaches to bunion surgery, no standardized procedure or protocol has been agreed upon. Ultimately, the decision on procedure selection depends on the surgeon’s preference, training, and experience. While this is successful most of the time, there is a percentage of cases that, despite the best surgical efforts, may go on to develop prolonged stiffness, under correction, and a recurrence of the deformity. Furthermore, in the past several years, there has been strong evidence in the medical literature that a large percentage of bunions involve a three-dimensional rotational deformity, rather than simply occurring in two-dimensions.  This may be a problem and can possibly explain some of these complications.   Most existing surgical procedures are only capable of providing two-dimensional correction.

Recent Studies – Lapiplasty

Fortunately, in response to the abundance of recent studies suggesting that a different approach may be needed to better correct some bunion deformities, a new system has been developed known as the Lapiplasty procedure.  A team of surgeons designed this procedure with the above concerns in mind. Several factors lead to the creation of this procedure; the lack of a standardized approach, under correction of the bunion, and recurrence of deformity. The Lapiplasty procedure incorporates a standard procedural technique for tri-plane correction and fixation protocol.  The procedure uses two small plates and screws to yield reproducible and consistent results for bunions of all severity levels.

A major advantage of this procedure is that it can allow a more rapid return to bearing weight.  As a result, patient may begin walking in a boot immediately after surgery, versus the traditional 6-8 weeks of non-weight bearing with similar procedures. The procedure is performed on an outpatient basis; you will have surgery, and go home the same day.

Lapiplasty is among the latest in bunionectomy surgery and has shown exciting and promising results, but, it may not be for everyone.  Only a trained surgeon can determine which, or if any, procedure may be right for you. If you have bunion pain but have been hesitant due to concerns about having surgery, give us a call!  The doctors at Kansas City Foot and Ankle will perform a thorough consultation and to find out which procedure may be best suited for you!  816-943-1111.