One day to go …

Today is just fun, as we are driving to Portland to have dinner with my daughter. Then we’ll spend the night and head to the surgery center in the morning. It’s an afternoon surgery (ugh!), so I don’t have to be there until 11:30 am. I’m not supposed to eat and drink from midnight, which isn’t going to be fun. It also shouldn’t be required.

According to the surgeon, I will have a nerve block that will last for the first thirty-six hours, so we’ll come home as soon as they discharge me. Then I have two weeks icing and elevating the foot. It will be in a splint but soft wrapped initially, and after two weeks, likely I’ll get a cast, though I still won’t be able to put weight on the foot.

Here’s the full scoop about what they’re going to do: http://www.aofas.org/footcaremd/treatments/Pages/Lapidus-for-Hallux-Valgus.aspx

General Details of Procedure

Typically, the Lapidus procedure is done on an outpatient basis. This means that the patient arrives one to two hours before the surgery time and goes home the same day.
The patient is routinely put to sleep with anesthesia to provide enough pain relief, relaxation and comfort during the surgery. In addition to the anesthetic, a nerve block may be offered to the patient to make his/her operative foot and ankle numb and give pain relief for several hours after surgery.
Typically, a single incision along the top or medial side of the foot is used to expose the first TMT joint. Once the joint is identified, the cartilage that lines this joint is removed and the bones are positioned and held straight with screws and/or a plate.

Specific Techniques

The Lapidus procedure starts once the patient is asleep from anesthesia. After an incision is made, the nerves and tendons


X-ray showing two screws placed across the first TMT joint in opposite directions.  Note that the joint line is not visible, which means that the joint has fused.

that lie under the skin are protected from injury. The first TMT joint is identified, exposed and then straightened out.  Usually, the top of the joint is worn down or degenerated while the bottom part of the joint is less affected. It is important to remove all of the cartilage from the joint to allow the bones to heal together.

After all of the cartilage is removed, the bones are straightened out. To maximize the success of the bones fusing together and straight, the surgeon uses screws running across or plates and screws along the side of the joint for internal support.
After positioning the first metatarsal and medial cuneiform bones straight with proper placement of hardware, some surgeons may add bone graft (from the patient or a cadaver donor) at the first TMT joint fusion site to further help the Lapidus procedure to heal. The incision is closed in layers with stitches or staples.  The patient is then placed into a well-padded dressing and either a splint or surgical shoe.

What happens after surgery?

Immediately after surgery, patients need to keep dressings clean, dry and untouched. The first two weeks after surgery are usually spent with the patient’s foot elevated to help decrease swelling. Within the first month of surgery, the patient’s stitches/staples are removed. With these removed, the patient is then placed into a cast, boot or surgical shoe and remains non-weight-bearing for another few weeks.
At the next appointment, the patient will receive foot X-rays to check on the healing of the first TMT joint fusion. So long as the bones are healing, patients are allowed to advance their weight bearing. Once the first TMT joint is fully healed, patients can wean out of their boot or shoe and return to their previous level of activity. Physical therapy may be recommended to improve foot and ankle strength and range of motion.
Some residual swelling and discomfort is normal up to a year after surgery.  Most patients are able to return to normal activities with minimal pain and/or problems by four to six months after the surgery.
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