Lapiplasty is an advanced surgical technique specifically designed for the correction of hallux valgus (bunion) deformities. Unlike traditional bunion surgeries, which primarily address the bony bump or realign the bones in one or two dimensions, Lapiplasty provides a comprehensive, three-dimensional correction. This procedure aims to correct the underlying deformity by addressing the joint’s rotation, angulation, and translation, offering a more lasting solution and improving overall foot function.
Functional Anatomy
The hallux valgus deformity involves an abnormal angling of the big toe, causing it to shift towards the second toe, while the first metatarsal bone moves outward. This results in the characteristic bunion bump on the side of the foot. The condition is caused by a combination of abnormal bone structure, soft tissue imbalances, and joint instability. Traditional bunion surgery typically addresses only one aspect of this deformity, such as shaving off the bony prominence or correcting angulation. However, Lapiplasty aims to realign the entire joint in all three planes: rotation, angulation, and translation.
Biomechanics or Physiology
The big toe joint (first metatarsophalangeal joint) is critical for pushing off during walking and running. A bunion deformity disrupts the natural alignment of this joint, leading to poor weight distribution, increased pressure, pain, and decreased function. The Lapiplasty procedure corrects the deformity in three dimensions, restoring the joint’s normal alignment and improving function by enhancing stability and balance during movement.
Common Variants and Anomalies
Hallux valgus can range from mild to severe. Mild cases may only involve a slight deviation of the big toe, while more severe cases may result in significant deformity, leading to difficulty walking, wearing shoes, and performing daily activities. In severe cases, the bunion can cause additional issues like hammer toes, calluses, or joint degeneration, which can complicate treatment. Lapiplasty is most beneficial in moderate to severe cases, particularly when traditional surgery has failed or when a more permanent correction is desired.
Clinical Relevance
Lapiplasty addresses the root cause of the bunion deformity by correcting it in all three planes, offering a more permanent solution compared to traditional procedures. Traditional surgeries, such as osteotomies, often result in bunion recurrence, especially in severe cases. By stabilizing the joint and realigning the bones in rotation, angulation, and translation, Lapiplasty reduces the likelihood of recurrence and improves long-term foot function, allowing patients to return to normal activities with less pain.
Imaging Overview
Preoperative imaging is essential for planning the Lapiplasty procedure. X-rays are typically used to assess the degree of bunion deformity, joint alignment, and the presence of any associated conditions, such as sesamoiditis or arthritis in the first metatarsophalangeal joint. A CT scan may be used in some cases to assess the exact 3D alignment of the bones before surgery. Postoperative imaging helps to verify the correction of the deformity and monitor the healing process.
Associated Conditions
Bunions are often associated with other foot deformities or conditions, including:
- Hammer toes and claw toes
- Flatfoot or pes planus, which can exacerbate bunion formation
- Arthritis in the metatarsophalangeal joint
- Hypermobile foot structures, especially in patients with conditions such as Down syndrome or Ehlers-Danlos syndrome
Lapiplasty is particularly effective in complex cases where multiple deformities or soft tissue imbalances are present.
Surgical or Diagnostic Applications
Lapiplasty involves a specialized approach to bunion correction, which includes:
- Making small incisions near the affected joint.
- Realigning the bones of the big toe joint in all three planes using advanced surgical instruments.
- Fixing the bones into their corrected position using screws and plates.
This comprehensive approach ensures that the joint is not only realigned but also stabilized, reducing the risk of recurrence and improving long-term function.
Prevention and Maintenance
After surgery, maintaining proper foot care and rehabilitation is key to ensuring a successful outcome. This includes:
- Wearing protective footwear to support the corrected joint.
- Using orthotics to maintain proper alignment and prevent strain on the foot.
- Physical therapy to strengthen the foot muscles and improve flexibility.
- Avoiding high-impact activities that may strain the foot before full recovery.
Research Spotlight
A recent study described the successful use of a modified Lapiplasty (three-dimensional correction surgery) for a young woman with Down syndrome, congenital heart disease, and severe hallux valgus (bunion) deformity. The authors emphasized that patients with Down syndrome often experience ligamentous laxity and flatfoot, making traditional bunion surgeries less effective.
By fusing the first tarsometatarsal joint and correcting the deformity in all three planes — rotation, angulation, and translation — surgeons achieved stable alignment and pain relief. The patient recovered well, regaining her mobility without recurrence. The study concluded that triplanar correction via modified Lapidus arthrodesis provides durable correction and is especially beneficial in complex cases involving hypermobility and flatfoot deformities.
This case reinforces the clinical advantages of Lapiplasty, as outlined above: its ability to correct the bunion deformity comprehensively and reduce recurrence by stabilizing the root joint structure. (“Study on 3D bunion correction in a patient with Down syndrome – see PubMed.“)
Summary and Key Takeaways
- Lapiplasty offers a comprehensive, three-dimensional correction for bunions, improving long-term outcomes by addressing the underlying joint deformity.
- It provides a permanent solution to bunions by stabilizing the joint and reducing the risk of recurrence.
- The procedure has been associated with rapid recovery, less pain, and improved foot function.
- It is particularly beneficial for patients with severe bunion deformities, hypermobile feet, or complex foot conditions.
- Postoperative care and rehabilitation are critical to ensuring the success of Lapiplasty and minimizing complications.
Do you have more questions?
What is a Bunion? What is Hallux Valgus?
A bunion is a bony bump that forms on the joint at the base of the big toe. It occurs when the big toe pushes against the next toe, forcing the joint of the big toe to get larger and stick out. This condition is often associated with the misalignment of the bones in the foot, leading to the formation of the bunion. This is also called hallux valgus deformity. Over time the metatarsal head (bony bump) will tend to drift and become more prominent.
What do patients with a Bunion feel?
Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will also tend to have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What are the symptoms of a bunion?
Symptoms of bunions may include pain, swelling, redness, and restricted movement of the big toe. In some cases, bunions may not cause any discomfort, but they can still affect the alignment of the toes and the overall structure of the foot. Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will tend to also have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What causes a bunion?
Bunions can be caused by various factors, including genetics, improper footwear, and certain foot conditions. High-heeled shoes and narrow-toed shoes can contribute to the development or worsening of bunions by squeezing the toes together. The pressure on the joint can lead to inflammation, pain, and the characteristic bony bump.
How do you diagnose a bunion / Hallux valgus?
Most bunion are diagnosed on clinical examination and X-rays.
What criteria is used to diagnose hallux valgus (Bunion)?
Your foot has a normal amount of outward angulation at the big toes joint. Less than 15 degrees is considered normal. This is called a Hallux Valgus Angle. 15-30 degrees is considered moderate deformity. More than 30 degrees is considered severe deformity. More than 40 degrees is considered a very severe deformity. We also use a measurement called a intermetatarsal angle. This is also elevated in hallux valgus deformity. Normally it is less than 9 degrees, but it can be elevated in hallux valgus. Treatment options change depending on the severity of your deformity.
What are treatment options for a bunion? Is there any treatment for bunions?
Treatment options for a bunions / Hallux Valgus include operative and non operative options. The goal of treatment is to reduce pain, increase mobility, and restore function. We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes. These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
What are non-operative treatments for a bunion? What is the treatment for bunions without surgery?
We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes. These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
Do non-surgical bunion treatments work?
In most cases of hallux valgus / bunions the deformity tends to get worse and worse. This will likely happen over years. As this occurs, your pain will tend to be more frequent and more severe. Non-operative treatment can help in less severe cases of hallux valgus. As the deformity worsens, as symptoms progress, non-operative measures are more likely to fail. Surgery is more likely indicated in severe cases.
What is Lapiplasty Bunion Surgery?
Lapiplasty is a type of bunion correction surgery. It an exciting new type of bunion correction that utilizes special guides / jigs to re-align the foot. It is combined with release of tight soft tissue structures and tightening of lax soft tissue structures. In doing this it corrects the bunion deformity.
How does Lapiplasty work?
The bunion is caused by a rotation and abduction deformity at the tarsometatarsal joint. We make and incision here, release the joint, and make bony cuts to allow the deformity to be corrected. We then apply places to hold it in this position, while the joint fuses. The corrects the deformity. We then make incision around the bunion to release the tight structures in between the 1 st and 2 nd toes. This can usually be done with a small incision and a releasing device. In some cases we have to make an incision over the bunion, remove excess bone, and tighten the soft tissue (capsule) on this side to correct the deformity further. Occasionally, in severe deformity, we have to make a bony cut in the proximal phalanx as well. This is usually fixed with a screw.
What to expect after Lapiplasty surgery? How long is recovery after Lapiplasty?
The surgery itself typically takes 1-2h and can be done as an outpatient procedure. You go home the same day in most cases. Following surgery, you will have a dressing on your incision and a cast on your foot. Ideally the area should remain completely dry until the staples / sutures are removed (2-3 weeks after surgery). We see you at 2 weeks after surgery to remove sutures and change the cast. You will go into a pneumatic walking boot at 2 weeks after surgery. We allow the bones to heal partially before you start weight bear. This means you start walking / weight bearing in a walking boot at 4 weeks post surgery. Physical therapy typically starts around this time as well. Surgery is painful. Most of the pain is experienced in the first few days. We give you strong pain medication and a pain management plan to address this. Swelling management is paramount. The foot will swell greatly after foot surgery. Icing and elevation are imperative. After the firstweek the pain tends to improve rapidly. I anticipate at two weeks post surgery the pain is much better. At 6 weeks most the pain should be gone. Swelling may be present for 6+ months after surgery. Eventually this returns to normal levels. This is the case for all foot surgery. Most patients are relatively pain free and have near full function of the foot around 2-3months after Lapiplasty.
Does Lapiplasty work?
Many studies have shown that Lapiplasty reliably corrects the deformity that cause bunion related pain. Furthermore, early results suggest that patient have excellent reduction of pain and are able to mobilize sooner than other methods of bunion correction.
Who is not a candidate for Lapiplasty?
Patient who would not be a good candidate for Lapiplasty are the same patient who are not good candidates for foot surgery. This includes patients with vascular disease of the lower limb, diabetes, end stage renal failure, smokers, and patient with a history of poor wound healing. The surgery would also be inappropriate in those patients who already have arthritis of the 1 st MTP joint (Bunion joint). Other foot deformities may preclude us from doing this surgery as well.
Are you put to sleep for Lapiplasty bunion surgery?
Typically, yes. Most of the time this surgery is done under a general anesthetic. Often it will be combining with peripheral nerve blocks for pain control.
Is Lapiplasty surgery painful?
It is as painful as most foot surgeries. However, we do our best to control your acute pain. This is done though nerve blocks, local anesthetic, and pain medication. Typically, after the 1-2 weeks, the pain is very manageable. The first few days are typically the worse. Most patients require opioid medication during this time. However, after that, most patients are able to cope with Acetaminophen and an anti-inflammatory.
How long does Lapiplasty bunion surgery take?
1-2 hours
What is the difference between Lapiplasty and regular bunion surgery?
Lapiplasty differed in the sense that the procedure is systematic. The guides and jigs used to correct deformity work well for all patients, all deformities, and all shapes of foot. They allow for reliable fixation. There is less guess work and more accuracy compared to traditional bunion surgery. It is success is quickly allowing it to become the most commonly performed bunion surgery in recent years.
Can bunions come back after Lapiplasty?
Bunions can recur after any surgery. However, this is usually because bunion correction is done at a young age. The younger you are, the more likely it will recur. Lapiplasty is a relatively new procedure, and the long-term recurrence rates are not known. However, recurrence rates for Lapidus procedures (on which the Lapiplasty is based) are very low.
Can Lapiplasty correct hammer toes?
Typically, no.
Can I wear heels after Lapiplasty?
Once you are fully recovered, yes.
Can you run after Lapiplasty?
Once you are fully recovered, yes.
How long after Lapiplasty can I drive? When can I drive after Lapiplasty?
Typically, you can start driving once the walking boot is discontinued. This is usually approximately 6 weeks after surgery
How long after Lapiplasty walk I drive? When can I walk after Lapiplasty?
Typically, patients are started walking / weight bearing approximately 4 weeks after surgery.
How long are you in a boot with Lapiplasty?
4-8 weeks
Is Lapiplasty covered by insurance?
Yes
Is Lapiplasty covered by Medicare?
Yes.
How much does Lapiplasty cost?
This varies from person to person depending on the insurance plan. We are happy to work with all insurance and figure out a solution to allow us to do this for you. Our billing agents are very helpful in this regard. Please feel free to have a conversation with one of them.
Who does Lapiplasty near me?
We can do the Lapiplasty procedure for you. Our foot and ankle specialist is well-versed in this procedure.
