Lapidus Procedure Questions and Concerns

Foot care
1

Hi everyone,

I'm scheduled to have a lapidus procedure for a bunion done on my right foot, this Monday 6/1/15. I'm in my early 20s, a nonsmoker, and more-or-less healthy. Like many other people, I am experiencing last minute reservations and fear about this process and was hoping to find some answers to questions that have come up for me.

I've been poking around the internet for the past few days, reading and watching people's lapidus experiences, and it's put some fear in me. I'm terrified! There's a lot of bad experiences out there. I honestly am not worried at all for the actual surgery, it's the pain that's freaking me out. So some questions for people who have survived this long ordeal:

How bad was your pain at its worst and what day post-op was it the worst? It seems to really vary among people, but if you could give me like a 1-10 rating or something that would really be great, as this is my number 1 concern.

What pain medications were you given, and how well did they work? I'm in the U.S., so names might be a little different.

How many days did it take for the pain to go away?

I also am slightly concerned about mobility so.. some questions for that too:

How long did it take you before you could crutch or hop or scooter around in the outside world and accomplish things like going out to dinner, seeing a movie, hanging out at a friend's house? Things that keep you sane!

My surgeon wants me completely non weight bearing for an entire 8 weeks. From what I've read, this seems a little excessive, as most people end up getting a walking boot or something similar. Has anyone else had that long of a NWB stage?

I'm extremely grateful for all the answers that I receive, and I wish you all pain-free, speedy recoveries! If you're lucky and have already recovered, congratulations!

2

I cannot understand why your surgeon is saying 8 weeks non weight bearing.  My surgeon was Prof Tagoe and if you google him you will read the advice postoperative and expectations.  6 weeks in boot and 6 weeks for the bone to fully fuse thereafter.  If you read my previous blog with regard to my experiences with both feet, this cannot be guaranteed.  One thing I want to say to you though.  I like you was terrified.  Don't be.  Ask your surgeon if he is going to give you a nerve block whilst under anaesthetic.  This should last for 10 - 48 hours approx.and will get you through the worst.  At the same time take Co-Codamol, regularly, don't wait for pain.  This will make you sleepy and you will get through it.  It is only really the first 4 days that are bad but with my first worse than my second.  when it was only mildly painful.  I found the first two weeks the most restrictive as you need to be feet up almost all the time and with crutches you have no hands so you need someone to fetch and carry.  It is amazing how you adapt though.  I can remember a coffee in one hand bottom going up and down stairs coffee coming with me 1  step at a time. Do not worry you will be fine and don't listen to horror stories it isn't as painful as you are imagining.  I am currently 15 weeks postoperative with my second Lapidus procedure and was unlucky with this one as the fusion took so long but am now out of all boots and learning to walk.  The biggest problem for me now is my weak swollen ankle which is the painful part but having had one foot done, I know I will get there in the end unlike the first one when I thought I'd never be able to walk properly again.  Please don't worry you will have a lovely foot and just think of being able to wear flip flops without worrying about your ugly foot!!

3

Good morning!  I too will be having a Lapidus procedure in July.  I too am going through all the emotions you are - but - guess what you will be over your op long before me.  I am 70 in July, with back pain, aches, etc, etc, so will not be sure where my pain is coming from but just thought - the pain killers might help all the other areas.

I have just looked at Prof Tagoe site for post operative advice, thank you Rosie, added to what my surgeon's site gives it all helps doesn't it?  I really think the more we research can be scary but we are going in with some knowledge and that has to be good.  

I know I was pleased I researched before my last operation as it gave me enough courage to change my mind at the last minute and go elsewhere. Hence, I could concentrate on recovery.  So 'yes' been there and done that! Looked at sights almost looked at op being carried out through half closed eyes.  BUT - I think there are some of us who just leave it in the hands of the professionals and there are those that need to find out.  This is site helps everyone and I am pleased I have found it.

Once again - good luck!  I will be watching your progress and waiting for all those tips.

4

Hi clairegen. I too was worried about the surgery. I had both feet done 9 weeks ago although it was scarf and akin procedure (dont know how different these procedures are). For me, the pain didnt seem too bad. I made sure i was taking all meds on time (co-codamol and ibuprofen) not letting the pain catch up with me. Worst day for me i think was day 3 or 4. But none of the pain was really as bad as i had expected. I had to sit with feet elevated for almost 6 weeks as it was unbearable for me to put my feet down with the rush of blood going to the feet. This changed overnight at the 6 week point for me and it was such a relief. I first went out for my grandaughters birthday at about 7 weeks. I did feel a bit uncomfortable but was just so glad i had made it because the week before i really thought going out wasnt going to be acheived. I am seeing a physio now, trying to walk normally again.

Having said all of this, reading this forum, you will see that everyone really is different and i have read stories of people being very active only 2/3 weeks in. You are very young and expect you may have a quick recovery. Good Luck to you for tomorrow and dont let the expectation of painn put you off.

5

Hello Clairegen.

I'm in England.And 6 weeks ago I had a akin and scarf procedure to both feet.I was heel weight baring in post op shoes straight after surgery....well when I was awake enough to stand up and hold my self.lol.

What is going to be done in the lapidus procedure?

I had 2 bad buinions......basically had osectomies and 3 screws put in each big toe joint.

I had to rest my feet alot the first 2 weeks.but could walk on heels around house.

For the shower as couldn't stand I got a shower chair.....they are really useful.Got mine of ebay.

And for going around....how about a wheel chair? I loaned a self propelling wheel chair from the red cross charity for 6 weeks. And its only one leg you cant wait bear in sure you would be able hobble to the car and into your stop whether friends or eat out.

I could bum shuffle up and down the stairs.

Oh and a good tip to help yourself, is to have small bag or pouch to carry bits around with you.as you wont have your hands.lol.

I had my xrays done Friday all healing well,am now back to driving my manual,walking...need to learn to walk again.

And can go cycling and swimming.Im not allowed to run or jump for a few months.and he didn't say anything about heels..though I will leave it a year or more before I try.

Pain....I felt pain on the scale 4/10 first few days.Then stopped taking painkillers and just aches.oh you may get a warm or itching sensation around your scars....thats them healing.😊

Good luck with it all xxx

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One other thing is that as far as going out for dinner, to friends etc. I would say if you have someone to collect or drive you then you can do everything after 2 weeks.  Don't forget your not I'll just temporarily disabled.  I found it an ideal time to be spoiled and was taken out for dinner regularly and had friends visit or I was collected and or taken.  There are some really good aspects of this surgery.  Lie ins in bed in the morning are a real bonus, coffee in bed etc.  Enjoy !!!

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Jessica, you say you had 3 screws in each big toe joint. Did you have the joints fused ?

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Hey Kelly.

I had a bone wedge cut out close to the big toe joint and rotation of the bone to straighten and a screw to fix in place.

And had a small bone wedge taken out nearer top big toe and rotation of the bone to straighten further and a screw fixed in.And had another screw to strengthen the bone and keep it place.

And then had a small incision made inbetween big and 2nd toe for tendon release.

This was done to both feet.

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Hi Jessica. I wish i knew exactly what Id had done too. I only know it was scarf and akin procedure. Both feet too and i have 2 screws and 1 staple in each foot too. I had a cut too between big and second toe as well. Never knew what that was all about. Did your surgeon speak you through it all?

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Jessica How's the recovery?

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Yes I have 2 screws and pin in each foot.

Yes your scar inbetween 1st and 2nd toe would be for tendon release.My surgeon told me my tendons were short and a added cause to the bunion forming.as they pulled my big toe intowards the rest,and my foot pushed against the tendon.forcing my bunion to protrude and get big!!

I had large bunions.

Yes he spoke to me and I asked.

If you have any questions feel free to ask.

How is your recovery going?

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HI jessica. Had my 6 week check with xrays 3 weeks ago. Everything ok. Was told to get back into suitable shoes and start walking again. He advised me that my swelling would take some months to go down. This is my worry just now as there is quite a bit of it and is making walking quite difficult. I feel as if i have a big stone under both feet. I am however trying to get a better step ie from heel through to toe and must admit that i do notice improvements here and i am getting about slowly. However when ive been on my feet even for say half n hour they swell badly and i feel like my feet are going to explode. I think i am probably just a bit impatient. How has your recovery been with you having both feet done too?

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I am now 6 weeks post op.

I am now driving,learning to walk again. As have been heal weight baring for almost 6 weeks,you need to make a concious effort to put heel to toe,to get foot back into normal movement.

Between 3-6 weeks I got around on my crutches for short distances.and loaned a wheel chair from the red cross for longer distances.I did my personal care myself.Had a shower chair.Bum shuffled up and down stairs.carried bag round with me to hold my bits.and drank from sports water bottle.

First 2 weeks,my friends mainly came to see me at home.But I could go to car,go for ride,and get out and hobblento destination.I rested alot too.Books,films,computer,ipod,phone all good to keep you busy first bit.

And the end result so happy!!!I am wearing trainers now for few months,then can try flip flops and dollies.Heels wouldn't try for a year.But I don't care if ever wear them again.so happy with having normal feet.

Exercise....at 6 weeks,now can swim,cycle,go for leisurely walks.and in few months do impact sports...eg running,jumping,tennis,etc.

Work....signed off completely first 8 weeks,then have slow reduced hours building up to full time,for 6 weeks.

Rem important to wiggle your toes!!

Scrunch together,spread out.

Try use toes pick a small object off the floor. And my surgeon use your toes to scratch the floor...gets all moving and build strength up.

And I use E45 moisturiser and bio oil for scars and regen skin tissue.

How far in recovery are you?or waiting to have done?

14

Hello Margot,

Please could you read comment below on this discussion posted in answer xx

Thanks 😊

Yes was told the same take months swelling go down.But have to say I haven't had much at all, but prob rest abit in between moving around.But yes be patient you will get there.😊.

I find stairs particularly tricky,or crouching down to pick something up.

Am walking for about 30-60 mins then lil rest.I can drive for up to an 1hr then need to rest.

How about insoles?

I personally dont use them.

But have read on here they are great for extra support!!

Either get some general ones in boots or another pharmacy.Or see a podiatrist who could make you personalised ones.they can be a bit expensive.

But do what you feel is needed x

15

Hi jessica. Good advice above to kelly. I can echo everything you said but was never told to wiggle my toes. My toes feel quite stiff although my physio says i have good joint movement in my big toe when she wiggled it from side to side. The exercises she has given me for now though is to get used to putting more pressure on my toes. Like you i find the stairs particularly hard, even no i just put my foot down flat and hope for the best.

I still rest a lot and too and do epsom salt soaks and bio oil for the scars. Im hoping not to need any aids for the shoes but will just take things as they come. Thanks for your invaluable advice.

16

Regarding the driving - I've not done that yet. Dont have an automatic but went out in car this afternoon and played about with the pedals (car on the driveway). It felt ok so goig to have another go tomorrow then notify insurance.  

17

Despite it being slow and long lol

You sound you are doing well.😊.

Do the exercises your physio said.

But from day 1 after op was told to rotate ankle,bring leg up and knee intowards chest,and to wiggle my toes as much was comfortable.but to stop when it hurt.but to repeat those exercises through the day reg.

Is important to keep the blood flowing....prevent clods...and build up the strength in muscles.

18

With driving I did that too...tested the pedals before went for drive.

But like you after 6 week xrays told could do some normal things again...including driving.

Well within an hour from being back from check up I was driving around my village.feels so good for freedom.

Butbof course like you are doing do as much as is comfortable.if start swelling,feel pain rest.x

19

Oh I drive a manual btw.

Feel I can drive alot more than can walk.i thought prob as not putting all my weight through my feet driving as when walking.

Good luck!!you will be back in your car soon and all the bricks will fall in place x😊

20

I think my surgeon is just being overly cautious. Hopefully if he sees I'm healing well, he'll okay me for some weight bearing earlier on.

Thank you for your encouragement!