One Surgeon’s Experience With Earlier and Fuller Weight-Bearing After Lapidus Bunionectomy

In his lecture at the APMA National, Lawrence DiDomenico, DPM, FACFAS, dives into weight-bearing trends after the Lapidus bunionectomy. Podiatry Today had the chance to talk with him about some of the key points of his lecture.

Q: How do you feel weight-bearing trends have evolved with respect to the Lapidus bunionectomy?

A:

Dr. DiDomenico relates that he feels the early weight-bearing continues to grow.  

“I began early weight-bearing (with these procedures) almost 20 years ago and soon realized it is much more patient- and physician-friendly and desirable,” he explains.

He adds that in his experience, the AO construct must be superb in order to do this well and safely. He goes on to say that in his practice, he has found that properly chosen, healthy, younger patients may progress to tennis shoes at 3 weeks, give or take, assuming all is going well and the patient is responding well.  

“I believe there is a mental-physical condition on how the patient progresses in many cases, hence the more they move, the more successful their outcome is, assuming we obtained good reduction and no complications,” he says. “It appears to me, more and more foot and ankle surgeons are beginning to weight-bear earlier. I believe this will continue as there are more and more foot and ankle surgeons allowing this successfully, as well as more literature to support it.” 

Q: What do you feel are some key benefits to early and full weight-bearing after a Lapidus?

A:

Dr. DiDomenico, in practice in Youngstown, OH, relates that he finds some potential benefits of earlier and fuller weight-bearing after a Lapidus bunionectomy may include:

·       reduced postop edema;

·       better range of motion;

·       more independence;

·       less need for assistance/hassle postop;

·       less risk for DVT/PE (no studies to support), but he relates that intuitively this makes sense;

·       better spirits of the patient and the foot and ankle surgeon;

·       gives the foot and ankle surgeon more confidence about performing a more complex procedure; and

·       able to get into physical therapy much sooner.

Q: What challenges should surgeons look out for when employing such a course (if any)?

A:

The key, Dr. DiDomenico says, is the AO construct. Without an advanced construct, he says he would be very cautious with employing early weight-bearing.

Q: What else do you want surgeons to know about this postoperative course?

A:

Overall, he adds that it Is more patient- and physician-friendly.

“The more confidence and success the surgeon has, he/she will perform more cases, as the postoperative course is much friendlier and better for the patient population. Probably more likely than not, he says, more patients will undergo the procedure with a friendlier postop course as opposed to the traditional non-weight-bearing for around 4 to 6 weeks.”