Modified lapidus fusion

Podiatric Surgery

Modified Lapidus Fusion (Bunion Surgery) Introduction

This leaflet will explain what will happen when you come to the hospital for an operation to repair a bunion deformity.

Why do I need this surgery?

There are many different types of bunion operations. The Lapidus procedure is normally recommended when the bunion deformity is large and when the joints of the foot are very mobile. It is often recommended when a bunion deformity occurs at a young age and when the bunion deformity is likely to reoccur. This procedure is also advised when there is pain or arthritis at the base of the first metatarsal bone (big toe). This operation usually results in a generally good correction of a large bunion deformity, but the recovery is longer than for other bunion operations.

The operation involves removing the surfaces of the base of the first metatarsal (big toe) and cuneiform (foot) bones and fixing these together with screws so that they fuse together. The operation is performed under local anaesthetic administered by a series of injections around your ankle or an injection in the back of your knee. This type of anaesthetic can take 24-36 hours to wear off, during which time you will also lose the ability to move your leg voluntarily. This provides a considerable advantage in that you need far fewer painkillers.

What does surgery involve?

On the day of surgery you will be admitted to the ward and one of the nursing staff will check you in, take your blood pressure and perform any other tests that may be required. The surgeon will remind you of the surgical process and possible complications and ask you to sign a consent form. Your foot will be numbed via a series of injections around the ankle and in the back of the knee. After this you must have help to the toilet and must not walk at all without help. You will be shown how to use crutches.

Day vice

At some point during the morning/afternoon you will be escorted to theatre. Once in theatre you will be made comfortable and we will check that your foot is totally numb. You may bring a personal stereo or iPod with you.

The operation takes about 90 minutes, during which time the bunion deformity will be corrected. Often X-rays will be taken in theatre. After surgery your foot will be bandaged and a below-knee plaster cast applied to protect the operation site.

After the operation you will be taken back to the ward and given something to eat and drink. You should start taking your painkillers. The nursing staff or your surgeon will answer any questions that you might have and you will then be discharged home with your escort.

You should not drive after foot surgery and should be accompanied home by a responsible adult.

You will be advised of your follow up appointment date, either on the day or by letter in the post.

1 PSI-2406-1713-10

Modified Lapidus Fusion (Bunion Surgery) How will I feel afterwards?

Although long-acting local anaesthetic administered during the procedure should control most of the pain for about eight to 10 hours, you can expect some pain or discomfort after the operation. Painkillers will be discussed with you prior to your operation and you should bring these with you on the day of surgery.

Recovering from surgery The first two days You will not be able to take weight on your foot after the operation, but you will be provided with crutches to help you get about. You will need to rest as much as possible with your leg elevated. You should limit activity just to going to the bathroom. Continue taking your painkilling tablets. After two days, please get up and move around the house as best you can for a total of 20 minutes within each hour, resting with the leg up at all other times. Do not put any weight on your casted leg and keep it dry.

At seven days You will be seen for a post-operative redressing in the outpatient clinic. The cast will be checked and, if needed, removed. But if you are comfortable the cast will be left on. Do not put any weight on your casted leg and keep it dry.

At 14 days The cast will be removed and the wound examined. The stitches are usually removed and a lightweight cast will be applied. If all is well, you will stay in this cast for another six weeks. Do not put any weight on your casted leg and keep it dry.

At eight weeks Your foot will be X-rayed. A further cast may be required, or you may go into a special boot: this depends on how well the bones are knitting together. Gentle weight bearing may begin. There will be some loss of muscle bulk and the skin will be dry. Apply moisturiser to improve the skin condition. An ice pack can be applied to your foot to reduce swelling. You will be advised about this.

At 12 weeks You will be seen again in outpatients. It is normal for your foot to ache when walking and it will still be swollen.

Continue regular ice packs. Your surgeon will probably advise you to start wearing wide, comfortable shoes such as trainers for the next few months. Gradually you will recover strength, flexibility and mobility. You should be getting back to normal activity by about four months, but the foot will continue to improve over a 12 month period.

Day vice

What are the possible risks and complications?

The outcome of surgery can never be guaranteed. Every operation carries potential risks. An audit of surgery within this unit has shown good results.

General complications of foot surgery Pain: There will be post-operative pain. For most people the pain passes after 24-48 hours and is tolerable with regular painkillers (following dosage recommendations).

Swelling: This is a normal outcome of any operation. The extent of post-operative swelling varies and cannot be predicted. In some people the swelling reduces within a matter of weeks and in others could take many months. Application of an ice pack greatly reduces swelling.

Infection:There is a small risk of infection with all surgery. If this occurs, it will be treated with relevant antibiotics. Look out for redness and discharge from the wound.

Deep vein thrombosis (DVT): Also known as venous thromboembolism (VTE), this is a rare complication of foot 2 PSI-2406-1713-10

Modified Lapidus Fusion (Bunion Surgery) surgery under local anaesthetic. The risk increases if you are having a general anaesthetic. There is also an increased risk if you smoke, take the contraceptive pill or HRT. Immobilising the leg in a cast also increases the risk of a DVT. If you have had a DVT in the past, please tell your surgeon. If you do have certain risk factors, you will have an injection to thin your blood on the day of surgery. This might need to be repeated for up to seven days following surgery.

Complex regional pain syndrome (CRPS): This is a rare but difficult complication. This is an abnormal response of the nervous system to surgery but can happen after simple trauma. This can lead to a variety of painful sensations in the foot, which require medical and pain relieving techniques.

Scarring: As a result of your surgery you will have a scar on your foot. To begin with, the scar will be raised, red and sensitive but with time it will usually settle.

Muscle wasting: This will occur as a result of not using the leg for several months after surgery. With exercises and normal walking muscle power is usually restored to pre-surgical fitness.

Specific complications of modified Lapidus fusion The deformity can reoccur. This may take years to occur and is not necessarily a problem.

Fusing a joint may increase the stress placed across other joints of your foot and can increase the onset of arthritic changes in other joints of your foot, especially if arthritis is already present.

Normally, the screws used to hold your bones in the correct position can be left in place. In about 6-8% percent of people however, they cause some irritation and need to be removed. This is a much smaller operation than the bunion correction. They can be removed after three months because the bones have healed by this stage and the screws have done their job.

Prolonged swelling can occur but is helped by ice applications, as instructed.

Shortening of the big toe can occur but this is usually minimal.

Your big toe joint may be stiffer than before. This is helped by exercising the joint regularly after the surgery when you come out of your cast.

Weight bearing can move to the outer edge of the foot after the operation and lead to transfer metatarsalgia (pain under the heads of the metatarsal foot bones). This may be treated with an insole in your shoe.

The bones can fail to fuse together. This is known as mal or non-union, and may be treated by staying in the cast, or it may require a further operation. The risk of this complication is higher if you smoke.

Day vice

Occasionally, one of the screws may break. This is a rare occurrence and if treatment is needed, it can be removed.

Rarely, you may feel the foot is worse after surgery than it was before.

This leaflet is intended as a guide only. The vast majority of patients who have a modified Lapidus have very good results. Occasionally, complications occur which would alter the normal post-operative recovery outlined in this leaflet. These will be identified and discussed at your follow-up appointments.

Useful numbers

Braintree Community Hospital Podiatric Day Surgery Unit

01376 555 900

01376 555 908

If you have any concerns during the first 24 hours following your discharge from hospital, please telephone the ward you were on. After 24 hours please seek advice from your GP. This document can be made available in other languages and formats upon request.

Podiatric Surgery at Braintree Community Hospital, April 2015. Review due: July 2019 3 PSI-2406-1713-10