The Lapidus procedure is an operation to fuse the first tarsometatarsal (TMT) joint at the base of the first metatarsal. It corrects bunion deformity at its origin — the hypermobile first ray — providing powerful, durable correction for moderate to severe hallux valgus.
An incision is made over the medial and dorsal aspect of the midfoot. The first TMT joint is exposed, the cartilage removed, and the joint fused using plates and screws. This corrects the metatarsus primus varus (the angular deformity of the first metatarsal). The bunion prominence is trimmed. A distal soft tissue procedure may be performed at the same time. The operation takes one to one and a half hours.
The Lapidus is recommended for moderate to severe bunions, particularly when there is hypermobility of the first ray, recurrent bunions after previous surgery, or first TMT joint arthritis coexisting with bunion deformity.
Wide footwear, bunion pads, toe spacers, orthotics. Distal metatarsal osteotomy (scarf, chevron) is an alternative for milder deformity.
Weight-bearing X-rays. Assessment of first ray hypermobility.
Powerful, durable bunion correction at the source of the deformity. Low recurrence rate. Good long-term results.
Non-weight-bearing for six weeks, longer than distal osteotomies.
Forefoot swelling for several months.
Expected — the joint is fused.
Failure of the TMT joint to fuse. Risk approximately 5–10%.
Pain under adjacent metatarsal heads.
The first metatarsal may heal in a slightly elevated position.
Plates or screws may need removal.
Low risk with Lapidus, but possible.
General or spinal anaesthesia with ankle block.
Non-weight-bearing cast or boot for six weeks. Weight-bearing in a boot from six to ten weeks. Normal footwear at ten to twelve weeks. Full recovery four to six months.
X-rays at six weeks, ten weeks, and three months.
The Lapidus corrects the deformity at its origin — the hypermobile first TMT joint. It provides more powerful correction for severe bunions and has a lower recurrence rate, but requires longer non-weight-bearing recovery.