Lapiplasty: A Permanent Approach to Bunion Repair

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By News Team on June 2, 2022

Monica Nicely had a bunion repaired years ago using a traditional surgical approach called a bunionectomy. When her bunion returned, she turned to Carilion Clinic's Foot and Ankle experts for a more lasting solution.

Ryan Putnam, M.D., a Foot and Ankle specialist at Carilion Clinic, suggested a new procedure called a lapiplasty.

"Lapiplasty is permanent," he said. "It’s kind of an exciting time to be able to offer something that you believe in and kind of change the mindset of what it used to be like."

What Are Bunions?

A bunion is a painful, bony bump that develops on the inside of the foot at the big toe joint. Bunions develop when the bones of the big toe move out of alignment and the toe begins to point toward the outside of the foot.

Traditional bunion repair surgeries remove the extra bone to narrow the foot again, but they don't address the underlying instability in the foot.

illustration of bunion in right foot by American Academy of Orthopaedic Surgeons
Bunions form at the MTP (metatarsophalangeal) joint when the big toe bones move out of alignment. Source: American Academy of Orthopaedic Surgeons

"One of the things to take into account is the sesamoid positions," said Dr. Putnam. "Those are two little bones under the big toe, like kneecaps in your knees. When they’re out of position, they’re sort of windswept underneath."

According to Dr. Putnam, lining up the sesamoids properly using the lapiplasty procedure reduces recurrence rates 10- to 12-fold.

He describes the repair like repairing a mailbox that's leaning over.

"You’re not going to cut it in the middle and try to rebalance it straight," he said. "You're going to dig it up, realign it, and resecure it at the base. That's what the lapiplasty system allows you to do." 

Is Lapiplasty Right for You?

Lapiplasty is not for everyone. If the big toe has arthritis already, repairing it would result in a stiff, straight toe that is still painful.

"For those patients, a fusion of the big toe joint is what we recommend," said Dr. Putnam.

That's his recommendation for patients with more complicated foot positioning issues as well. 

"Extreme flat foot or metatarsis seductis, where the metatarsals are sort of pointing in the wrong direction, often require adjacent procedures," he said, "so it’s not just about fixing the bunion, it’s having to do with midfoot malalignment and hindfoot malalignment."

Children are not good candidates for lapiplasty either. Because of their genetic nature, bunions can begin to form in children's feet before they are finished growing. That's the case in Monica's family, as her 12-year-old daughter is beginning to show signs of a bunion forming. Repairing it will wait until she's fully grown.

In the meantime, Monica has plans to return to Dr. Putnam's office to repair the bunion on her other foot. 

Dr. Putnam is the first surgeon to bring the new lapiplasty procedure to our region. Find out more by talking with your primary care physician or visiting CarilionClinic.org/ortho.

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