Arthrodesis of the 1st tarsometatarsal joint (Lapidus procedure) is a surgical procedure used for the treatment of big toe pain. It involves the articulation between the first metatarsal bone and the medial cuneiform. The surgery includes:
The removal of the cartilage surfaces from both bones,
the correction of the angular deformity and then,
insertion of hardware (screws and often a small plate) to allow the two bones to grow or articulate.
Arthrodesis of the 1st tarsometatarsal joint is used to correct a big toe neck deformity with a very large angle or when there is increased mobility of the 1st tarsometatarsal joint. When this joint becomes hypermobile, the first metatarsal moves too much in one direction and the big toe compensates by moving too much in the other direction. When this happens, the deformity of the big toe neck develops.
The goal of the Lapidus procedure is to surgically treat the big toe neck caused by hypermobility of the 1st tarsometatarsal joint. When arthrodesis of the 1st tarsometatarsal joint is achieved, the first metatarsal will not move abnormally. This will allow the first finger to remain straight and reduce the risk of recurrence of big toe pain.
Arthrodesis of the 1st tarsometatarsal joint – Symptoms
Symptoms which, if present, predispose to Lapidus surgery include:
the appearance of swelling at the base of the big toe, which contacts the inside of a shoe
pain and/or hypermobility in the 1st tarsometatarsal joint. When patients have fairly severe big toe pain due to hypermobility of the 1st tarsometatarsal joint, the foot may be so wide that it is difficult to find shoes that fit.
Pain that does not improve with non-surgical treatments, such as the use of special shoes and insoles.
Lapidus surgery can be performed on a day-to-day basis. This means that the patient can go home the same day as the surgery. It is performed under general anaesthesia, so the patient is fully asleep or a regional nerve block is used.
Lapidus surgery is often a part of surgery to correct big toe pain. Once the large exostosis at the base of the big toe is removed, and after the articular surfaces of each bone are removed, the alignment is corrected and the bones are compressed along with the implants (screws, plate-screw combination). Patients are usually immobilised in a splint or boot for the first two weeks after surgery to allow the incisions to heal. Full weight-bearing of the limb is often prohibited. Approximately six weeks after surgery, patients are mobilised with full weight bearing in either the boot or a special shoe, and then gradually transition to normal shoes 1-2 weeks later. Some residual swelling is normal up to one year after surgery. Most patients can return to normal activities with minimal pain 4 to 6 months after surgery.
If you are experiencing any of the above symptoms, trust Dr. Anthony Petta for an accurate diagnosis. The doctor has specialised in Orthopaedic Surgery and Traumatology in Stockholm. He has extensive experience in foot and ankle surgery, gained in hospitals in Sweden, Finland, Norway and Switzerland.