What Is Lapiplasty? Understanding 3D Bunion Correction
Lapiplasty is a patented bunion surgery that corrects the deformity in all three dimensions—sideways drift, upward elevation, and bone rotation. Unlike traditional bunion surgery that just shaves the bump, Lapiplasty rotates the entire metatarsal bone back to its natural position and permanently stabilizes the unstable joint with titanium plates.
Here's what most people don't realize: Research shows that 87% of bunions<sup>1</sup> involve misalignment in all three planes—sideways (transverse), front-to-back (sagittal), and rotational (frontal). That's why we call them triplanar or 3D deformities. Traditional surgery only addresses one or maybe two of those planes, which is exactly why bunions come back.
The name tells you what it does. Lapiplasty combines "Lapidus" (a surgical technique named after Dr. Paul Lapidus who developed it in the 1930s) with "plasty," which means molding or reshaping. But modern Lapiplasty is far more sophisticated than the original technique—it uses specialized instrumentation to achieve precise 3D correction and biplanar titanium plating that allows you to walk in a boot within days.
Think of your first metatarsal bone—the long bone behind your big toe—as a tall building like the Leaning Tower of Pisa. In a normal foot, this building stands straight. But with a bunion, this building isn't just leaning sideways—it's also rotating and lifting up, creating a three-dimensional deformity.
Traditional bunion surgery is like shaving off the part of the tower that's sticking out. That might look better temporarily, but the unstable foundation's still there, so it leans again. Lapiplasty rotates the entire tower back to vertical, realigns the foundation, and permanently secures it with titanium plates.
The key difference? Lapiplasty addresses the unstable joint in the MIDDLE of your foot—not just the bump on the side. That joint, called the first tarsometatarsal (TMT) joint, is where your metatarsal bone connects to the rest of your foot. When that joint is unstable, it allows the bone to drift. This patented surgical procedure fuses those two bones together (a process called arthrodesis) to create permanent stability.
Why Do Bunions Happen? The Unstable Foundation
Blame a parent or grandparent. Bunions are primarily genetic—you inherit an unstable first TMT joint that allows your metatarsal bone to drift outward over time. The bump you see isn't new bone growth or calcium buildup. It's your normal joint being pushed out of position.
Here's the actual mechanism. When that TMT joint in the middle of your foot is unstable, your first metatarsal bone gradually drifts outward. Your big toe compensates by drifting inward toward your other toes. This creates a vicious cycle—the more the metatarsal drifts out, the more the toe drifts in, and the bump gets progressively worse. What you're seeing is your normal anatomy in the wrong place.
The medical term for a bunion is hallux valgus, which literally means "big toe turned outward." Research shows that if one of your parents has bunions, you've got about a 50% chance of developing them too.<sup>2</sup> It's not a question of IF the unstable joint will cause problems—it's WHEN.
But genetics isn't the whole story. Certain factors accelerate progression, even though they don't actually cause the bunion. High heels and pointed-toe shoes put tremendous pressure on that already-unstable joint, speeding up the drift. High-impact activities, foot structure like flat feet or high arches, and age-related hormonal changes that make ligaments more lax—all of these make an existing problem worse faster.
Here's what most people don't realize: tight shoes don't CAUSE bunions any more than reading in dim light causes nearsightedness. But just like dim light can strain eyes that are already predisposed to vision problems, tight shoes absolutely accelerate bunion progression. Think of it like genetic predisposition to high cholesterol—diet doesn't cause the problem, but it makes it worse faster.
Why does this matter for treatment? Because the root cause is an unstable joint, not just bone position. Any treatment that doesn't stabilize that joint will eventually fail. This is why 70% of traditional bunion surgeries result in the bunion coming back—they repositioned the bone but left the unstable foundation untouched.
The Truth About Traditional Bunion Surgery
Most people think bunion surgery just "shaves down the bump" and you're done. And unfortunately, that's exactly what traditional bunion surgery DOES do—which is why 70% of patients see their bunions come back.<sup>3</sup>
Here's what traditional bunion surgery approaches typically involve. First, there's a bunionectomy, where the surgeon shaves off that bony prominence on the side of your foot. Then there's an osteotomy, where they cut the metatarsal bone and shift it over to address the sideways drift. Finally, they realign the soft tissues—tightening ligaments and tendons to hold everything in place. It sounds comprehensive, but there's a critical problem.
Traditional surgery only corrects one or two dimensions. It might address the sideways drift and maybe the soft tissue alignment, but it doesn't correct the bone rotation or elevation. And it absolutely doesn't address the unstable TMT joint in the middle of your foot—the foundation that caused the problem in the first place.
It's like putting a Band-Aid on a broken foundation.
The recovery tells the story too. With traditional bunion surgery, you're typically non-weight-bearing for 6-8 weeks. That means crutches, a scooter, or a wheelchair for nearly two months. The single-plane fixation—usually screws or wires—just isn't strong enough to allow you to walk while the bone heals. And even after that, it takes 4-6 months to return to full activity.
But here's the real problem: the statistics. Studies show recurrence rates as high as 70% with traditional approaches. That's not a small number—that's the majority of patients watching their bunions slowly drift back over the years. You also see less predictable outcomes and higher rates of transfer metatarsalgia, which is pain under the ball of your foot from abnormal pressure distribution.
I've treated dozens of patients who had traditional bunion surgery 5, 10, or 15 years ago. They thought they'd fixed the problem. But because that unstable joint was never addressed, the deformity came back. That's not a failure of the surgeon—it's a limitation of the technique.
Houston Podiatrist Explains When Lapiplasty Is Right for You
Patients always ask "Doc, do I need bunion surgery?" My answer's always "You tell me, I don't tell you!"
In my opinion, patients should elect for bunion surgery when you can't wear the shoes you need or want to wear, OR you can't do activities you want to do without significant pain. It's about quality of life, not X-rays.
I've had patients who work at the Texas Medical Center standing all day in professional shoes—for them, the decision came when they couldn't make it through a shift without significant pain. I've had Houston marathon runners who couldn't train properly. And I've had patients whose bunions simply made finding any comfortable shoes impossible.
Your "threshold" for surgery is personal—it's about what matters to YOU.
But before we even discuss Lapiplasty, I want to make sure we've tried conservative options. Here's how I approach bunion treatment:
Level 1: Proper Footwear
Sometimes, that's as simple as changing your shoes. Wide toe box shoes that don't compress the bunion can reduce pain by 30-50% in mild cases. Look for shoes with low heels—maximum 1 inch—and soft, flexible materials. Avoid anything with a pointed toe that squeezes your forefoot.
Now, for some of you, these swaps may be enough to manage symptoms and slow progression. But I need to be honest: changing shoes won't reverse the deformity. It won't rotate that bone back or stabilize the unstable joint. What it CAN do is make you more comfortable and potentially delay surgery.
Level 2: Custom Orthotics
When footwear alone isn't enough, we can add custom orthotics molded to your specific feet to redistribute pressure away from the bunion. Think of them like eyeglasses for your feet—they compensate for the problem while you're wearing them.
In our Houston practice, I see custom orthotics manage symptoms in 60-70% of early-stage bunions. The cost's $700 for your first pair and $350 for additional pairs. They don't fix the structural problem, but they can make living with a bunion much more tolerable.
Level 3: Injections for Acute Inflammation
If you're experiencing acute pain from inflammation around the bunion joint—what we call bursitis—a cortisone injection can provide temporary relief. The cost is $120, and you'll typically get relief that lasts anywhere from a few weeks to several months.
Here's what I want you to understand: this doesn't fix the structural problem. It reduces inflammation. For some patients, that's enough to get through a particularly painful flare-up or to buy time before they're ready for surgery.
The Third Option: Regenerative Medicine
What's exciting is that we now have regenerative medicine options like shockwave therapy or PRP injections that can help manage bursitis or inflammation around the bunion. Shockwave therapy uses acoustic waves to stimulate healing, and PRP uses your own concentrated platelets to reduce inflammation.
However, I need to be honest: these treatments can't rotate a bone back into position or stabilize an unstable joint. They're excellent for soft tissue problems—tendonitis, bursitis, inflammation—but they're limited for structural bone deformities. I've had patients get significant relief from the pain around their bunions with these approaches, but the bunion itself doesn't change.
When Conservative Care Reaches Its Limit
If you've been managing your bunion with proper shoes and orthotics for 3-6 months and your pain is still affecting your life—or if the bunion is visibly progressing despite your efforts—that's when we talk about Lapiplasty.
Look, I know that foot surgery sounds scary. Patients tell me all the time they've been putting it off for years because they're terrified they won't be able to walk for months. Here's what I want you to know: Lapiplasty recovery is faster than traditional bunion surgery, and most patients tell me they wish they'd done it sooner.
Ideal Candidates for Lapiplasty
You're likely a good candidate for Lapiplasty if you have moderate to severe bunions with 3D deformity, you've tried conservative treatment for 3-6 months minimum without adequate relief, your bunion's causing functional limitations in your daily life, you're in good overall health for surgery, and you have realistic expectations about the recovery process.
The surgery itself is performed in an outpatient surgical center. You're under anesthesia for about 90 minutes. We make a small incision on the inside of your foot, use the specialized Lapiplasty instrumentation to correct all three dimensions of the deformity, and secure everything with biplanar titanium plates.<sup>4</sup> You go home the same day with a bandage and splint.
Who's NOT a Good Candidate
I DON'T recommend Lapiplasty if your bunion pain is adequately managed with conservative care, you have significant medical conditions making surgery too risky, you're not willing to commit to the recovery protocol, or your bunion isn't significantly affecting your quality of life.
The No-Judgment Approach
I won't judge you if you decide surgery isn't right for you. And you can always choose to continue managing your bunion conservatively and revisit the surgical option later if things change. Either way, I need to see you to figure out what's going on and what your best options are.
If you're considering Lapiplasty and want to know if you're a candidate, contact Houston podiatrist Dr. Andrew Schneider at 713-785-7881 or request an appointment online. I'll evaluate your specific bunion, examine your foot mechanics, and discuss whether Lapiplasty is the right approach for your situation.
What to Expect When You Come to Our Houston Office
When you come in for a Lapiplasty consultation, here's exactly what will happen—no surprises.
I start by asking about your goals. What do you want to be able to do? What shoes do you want to wear? What activities matter to you? This isn't just small talk—your goals determine whether surgery makes sense. Some patients need to stand all day at work. Others want to run marathons. Some just want to wear dress shoes for special occasions without pain. There's no wrong answer, but I need to understand what success looks like for YOU.
Then I'll examine your foot. I'm going to assess the severity of your bunion and look at how the bone's drifted in all three dimensions. I'll check the range of motion in your big toe joint to see if there's any arthritis. I'll evaluate your overall foot mechanics and watch you walk to understand how the bunion affects your gait. And I'll look for associated conditions like hammertoes, flat feet, or arthritis that might need to be addressed.
Next, we'll take weight-bearing X-rays—that means you're standing, not sitting. This is critical because bunions look different when you're putting weight through your foot. I'll measure the deformity angles, assess any joint arthritis, and look for other structural issues that might affect your treatment plan.
Here's where we talk through options. If you haven't tried conservative care yet, that's where we start. Proper footwear, custom orthotics, maybe an injection if there's acute inflammation—we'll exhaust those options first. But if you've already been managing conservatively for months and you're still in pain, then we discuss whether Lapiplasty's the right choice.
I never push surgery. You decide what's right for your life. X-rays tell me what's happening with your bones, but your symptoms and goals tell me whether surgery is right for you. If you're not ready, that's fine. If you want to think about it, that's fine. And if you're ready to schedule, we'll handle the insurance authorization and get you on the calendar.
The new patient visit is $185. If we need X-rays, that's an additional $90. The appointment typically takes 30-45 minutes. And if we decide together that Lapiplasty is the right approach, we'll schedule a consultation with the surgical center and get everything coordinated.
