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Old 11-05-2005, 08:10 AM   #1
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Question Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

Good morning - I know I'm asking for details a bit late in the game (my surgery is scheduled for Monday), but am hoping someone will run across this, who has had this procedure, and hopefully the other one I'll be having also. I found a great site that shows a little movie of what the Lapidus procedure is/does:

http://www.physicianwebpages.com/lapidus.html

(Sorry, I couldn't get it shop up as clickable link - you'll have to copy/paste)


In addition to that, my pod will be doing an osteotomy to shorten 2nd metatarsal, and will fuse that as well. I'll be in non-weight-bearing cast for at least 6 weeks, then probably in boot for some weeks after that. Because I have major back problems (2 previous 3-level fusions - 1st one failed, 2nd one is fused but didn't resolve much of the pain - also have 2 more bad discs right above fusions), I'm worried about what being on crutches is going to do to my back pain levels.

SO, has anyone had similar surgery, who can tell me what your recovery was like, how were your results, etc.? Anything I can/should do in preparation? (I have frozen some meals and am planning to make sure my house is cleaned pretty decent so I don't have anything I could trip on (I have 2 kids who are in the habit of sometimes leaving a thing or 2 lying around) (Of course I'm as big a culprit as they are!)

Did anyone here get that Xero-something waterproof cast cover? I'm wondering if it's worth the $30-something, or if I should just stick with duct-tape and garbage bags when I shower? Anything else I should be preparing ahead of time?

How were your pain levels? Tips for sleeping? I guess I'll have a "huge puffy dressing" on foot for the first 4 days, then go to dr. and he'll put on fiberglass case (non weight-bearing).

Any other things I should be aware of, that I'm not thinking of???

Thank you for any input!

JD

Last edited by Midwest-JD; 11-05-2005 at 08:14 AM. Reason: correct the link

 
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Old 11-05-2005, 08:29 AM   #2
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

Forgot to ask: They are doing this surgery with a local (epidural?) and IV-sedation, rather than general anesthesia. I really hoped I would be totally OUT cold... Have any of you had similar done with just IV sedation? (Nurse said I'd be awake but a bit "out of it") I want to be WAY "out of it"!!! Opinions on this? Which is better? Will I actually be awake???

 
Old 11-05-2005, 08:34 AM   #3
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

I had the iv sediation with a nerve block. I think it is the best way to go. When you see the anesthesiologist, just mention to him/her that you would like to be out-of-it, and they will probably comply. I don't remember a thing other than some voices when the procedure was done. Also, no side effects with this approach.

I'm not familiar with your procedure, but wish you the best of luck!

 
Old 11-05-2005, 09:10 AM   #4
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

One other thing. There is some information on this board about alternataives to crutches - specifically a rolleraid I believe. You put your knee on a padded shelf and roll yourself around. Sounds much easier on the back. Also, I remember someone mentioning getting a small bean bag chair to rest your foot on after surgery. I thought that was great advice, so i bought a bag and took a lot of the beads out so it would be the right height for me to rest my calf on, keeping my foot above the heart while lying down.

 
Old 11-05-2005, 09:22 AM   #5
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

JD, I had a cast on for 4 weeks this summer and we spent a week at a lake so I bought the Xerosox. It works really great and I swam all week with it. The casted leg just floats. It takes a while to get on as you have to suck all the air from it but is great if you don't want to be without swimming. If it's just for the shower, I bought a slip-on thick plastic cast cover with a ring of plastic at the top from the local drug store. Was about $22.00. Sure beats the garbage bag and duct tape. It's in the pharmacy section. Just ask them if you're interested. Water never leaked through the rubber ring.

Sure wish I was having the IV sedation but I am being told I will have a general. Wonder why the difference? I guess each surgeon has his own method. Best of luck on Monday and let us know how you fare!

 
Old 11-05-2005, 05:38 PM   #6
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

I had the Lapidus procedure done on June 27 '05. Initially I was going to go with IV sedation, but I was very very nervous when I got to the hospital and the anesthesiologist decided for me that general anesthesia was the way to go. Next thing I knew I was waking up in the recovery room. I was nauseous that day, but other than that there were no side effects.

I have two permanent screws midfoot and two external pins to hold the toe joint osteotomy in place. I was totally non weight bearing for seven weeks. I took the first three weeks off work and returned the fourth week on crutches (I had a desk job). It took me a while to get the hang of the crutches, but I was up and down several flights of stairs a day, so I was a pro in no time. I couldn't drive for seven weeks though.

Pain management wasn't that bad. I made sure to keep the foot elevated and to take the pain medication on schedule, even if you don't think you need it, just to keep on top of the pain.

My pins came out at seven weeks and I started wearing a walking cast. I wore that for another month and now, at four months past my surgery, I amweraing sneakers and a dressier shoe for part of the day if I'm working.

I started physical therapy at 6 weeks (and that was late) and just finished this past week. I had a lot of trouble regaining motion in my toe, and even after several months of therapy, I still only have 65 degrees of motion in the big toe (you should have 80-90 degrees, normally). I have eto stretch it every day.

One of the biggest pieces of advice is to move the toe as soon as the podiatrist gives you the okay. Move it a lot and often. I was non weight bearing for so long that I lost ALL the muscle in my calf and ankle and restrengthening that is almost as hard as regaining the toe motion. MOve the toe and ankle as soon and as often as you can.

Let me know if you have eany other specific questions about the Lapidus fusion. I'll do what I can to help based on my experience.

 
Old 11-05-2005, 05:48 PM   #7
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

Thank you for your replies - I didn't think about elevating the foot. I bet the bean-bag would work great! Much easier than a big pile of pillows that will all want to slip around all over the place! I do have have an extra-thick set of pillows on my bed that go under my knees when I sleep (this for my back problems) - now I need to add more pillows (or bean-bag chair!) to keep the foot up as well, instead of just the knees.

I will check the drugstore for the cast-cover - don't think I'll be doing much swimming in Northern MN in Nov. and Dec! (so probably don't need the more expensive and time-consuming xero-cast-cover-thingie - sounds great though!) I will keep it in mind though in case I decide to go to the Y to use their pool! I'm going to go crazy not being able to use my treadmill - I walk on that religiously 3-4 times a week, even though I have to walk slower than I used to, and for half the time I used to, I really feel like it helps me stay more mobile with my back problems and arthritis when I can get regular exercise.... (not to mention the health benefits...) So I MAY end up doing the Y thing just for a couple months so I could swim... (I can get registered with no sign-up fee and half-price rates because my pain-management doc signs letters asking for reduced rates for his patients, as he considers it part of their "therapy".)

It's been so long since my last foot surgery, I think I've pretty much fogotten everything! Except that back then - '81 and '82 - I had a LESS invasive surgery (chevron osteotomies with bunionectomies) and spent 3 days in hospital each time!! Even had a few sessions with PT for them to teach me how to use crutches - going up and down stairs even. What a difference! Now it's a worse surgery, and they send you home in a couple HOURS! Pretty soon it'll truly be "drive-thru" surgery! The nurse who called me on Friday (with times/details for monday) asked if I had crutches to bring them along, but said I'd be only in bed or wheelchair the whole time I was there, so apparently they don't even give you a 5-minute primer on crutches anymore??

A friend from a chronic-pain board I go to said that her daughter had been through several foot surgeries, and she had some kind of thing that went under her boot, that would run ice-water through it, to "ice" the foot. Has anyone had something like that? Is it something they can put under a cast?? That would be awesome! I use ice-packs ALL the time for my back, and they really do help - I would think they'd be great for a post-op foot! I"m going to ask about that on Monday morning - they probably won't even know what I'm talking about.

Why wouldn't you want general anesthesia? Nausea maybe? I guess I've not had that problem when I've had general before - though I did have a terrible asthma attack about 2-3 hours after my last back surgery (which was about 6 hours long, and they think it was triggered by the excessive IV fluids during the long surgery - fluids started backing up into my lungs), and had naso-gastric suction tube previously, so there was nothing in my stomach to make me nauseous either.

Well, again, thank you for your input! I wish I had popped in here a few weeks ago. I've been in denial - purposely not thinking about the surgery until the last couple days, when I've been in "get ready" mode (cooking for freezer, cleaning, buying loose-legged sweat-pants (found some nice dressy *very* wide-legged "gauzy" pants last night at Wal-Mart, on clearance for $5!! Woo-Hoo!! )

Have a great night and Sunday!
JD

 
Old 11-06-2005, 05:52 AM   #8
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

Hi JD,

I just had a bunionectomy, the lapidus procedure and the bunionette shaved off (no screws or anything) on 9/20/05. I had general anesthesia and a nerve block done. I too was concerned about the nausea, so I talked to the anesthesiologist about it and he gave me something through my IV for it. I felt great when I woke up.
My surgeon gave me tylenol with codeine for pain. I was taking that right after I woke up and every time interval after that. Even so I had pretty painful throbbing the night after and I got a prescription for Percoset. It worked wonderfully. So, I took the Percoset for 3 days, the Tylenol with codeine for the next 3 days, and then regular Tylenol for another 4 days. Then I was off any kind of pain meds. The next time I do this, I will make sure and get a prescription for vicodyn or percoset and take that right off the bat for the first few days. I had no problems sleeping while I was on the prescription meds, I would be knocked out within 20 minutes of taking them.
I was completely non-weight bearing for 6 weeks. I had my foot wrapped in gauze and then had that knee-high rocker boot on. I couldn't take it off for the first 2 weeks. I didn't buy a cast cover, I just taped a trash bag over it when I took a shower - it worked great. I also didn't buy a shower chair, I just put this huge cooler in the shower and sat on that. It's definately not as safe as the chair. If you put your weight in the center of it, you'd be fine. I don't know that I'd recommend it because I did fall pretty hard once.
My first follow-up was exactly 2 weeks after the surgery. I had x-rays done and the stitches taken out. I don't want to say this to scare you, but that has been the most painful part. I didn't take any pain meds before getting the stitches out, I didn't know it would be painful. So, next time I'll definately take pain meds before the stitches come out.
So, after the stitches came out, I just had the boot on. It was nice because the doctor said I could take it off to sleep, which was great. I could take it off when I showered too. I also did minimal exercises per his instruction. I did bend my big toe gently and did range of motion exercises for my ankle 3x per day.
I just went back last week for another follow-up (6 weeks post-op). I had x-rays done. I'm also still on crutches doing the progressive weight-bearing thing. They're having me put 25 lbs of weight on that foot for 3 days, 50 for the next 3 days and so on until I get to my full body weight. Then, I walk normally without the crutches (but with the boot still on) for a week. Then I can try wearing a normal shoe. I'm also doing exercises with a stretchy band my doctor gave me. The only thing I've found is that my ankle has gotten somewhat sore after putting weight on it again (it's not painful though). I'm pretty sure that's normal.
Anyways, sorry to write a book, but it really helped me reading about other people's experiences before I had my surgery. I'm really glad I did this. Good luck with your surgery tomorrow!!!

 
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Old 11-06-2005, 07:10 AM   #9
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

Wow - Thank you, Ipsa and Jeanobug for your helpful replies! I agree, it helps a lot to read what others have gone through, what it was like, etc. I will definitely talk to the anesthesiologist and ask them to PLEASE KNOCK me OUT!

I've never gotten nauseous from anesthesia, but will also ask about the anti-nausea med as well, just to be sure.

Thanks again to all who have replied - you've helped me immensely.

JD

Last edited by Midwest-JD; 11-06-2005 at 07:13 AM. Reason: correct spelling

 
Old 11-06-2005, 08:14 PM   #10
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

Good Luck in the morning Midwest-JD...I'll be thinking of you!

 
Old 11-06-2005, 09:05 PM   #11
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Re: Lapidus procedure (mid-foot fusion)anyone? What is recovery like? How to prepare?

Thank you, SF-Sophie! I appreciate that! I'm just getting ready to take an Ambien so I can sleep - I'm so wired tonight I don't think I'd sleep more than a couple hours without it. With my previous (spine) surgeries (2 major and one minor), I've always asked my doc to Rx me a few Ambien, so I can sleep the last couple nights before "it", and the first several nights after it. SO, I'm off to La-La-Land - Nighty-Night! If I have time in the morning I'll check in.

Sleep well! (I will!)
JD

 
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