How to take care of my foot and ankle after surgery.
What happens on the day of surgery?
Patients should be well prepared before surgery. Surgery may be performed at a designated hospital or a surgery center. Patients usually receive a phone call a day ahead to remind them about the surgery. It is crucial that food and drink are avoided after midnight before surgery. Dr. P will meet with the patient just before surgery to mark the surgical site and confirm the details of the surgery.
After the surgery is completed, Dr. P will meet with a family member to explain the operative finding and postoperative care. Patients usually stay in the recovery area for 1-2 hours prior to discharge home or admission to the hospital depending on the type of surgery.
How is my pain managed after surgery?
Postoperative pain control is critical to maximizing the patient's comfort. For major surgeries, nerve blocks may be discussed and provided by the anesthesia team. Nerve blocks allow pain to be mostly eliminated for the duration they are working ranging from one to several days. Some patients may experience a prolonged decrease in sensation in certain locations, but they almost always recover entirely. Patients should discuss the risks and benefits of a nerve block with the anesthesia team prior to making a decision about it. Smaller surgeries such as arthroscopies and minimally invasive surgeries may require only a local anesthetic to help with pain for 4-6 hours after surgery.
Patients are monitored for pain and may receive oral or intravenous pain medication in the recovery room or during admission. After discharge, pain is also managed by oral pain medication, icing, activity modification, and anti-inflammatory medication. It is encouraged that patients gradually wean themselves off from narcotics as soon as possible to avoid side effects and addiction.
How can I get around after surgery?
Depending on the type of surgery, weight-bearing may be categorized into full, partial, or none.
Small and arthroscopic procedures often allow patients to put full weight on the operative foot or ankle. Patients should consider using crutches or a walker for balance to prevent falls. If prolonged walking or standing is expected, a knee scooter may be a good adjunct for those activities.
Moderate size procedures may allow partial weight-bearing on the operative limb. the amount of weight-bearing on the limb varies from touchdown (25%), 50%, to 75% while the rest of bodyweight is supported by crutches or a walker. If prolonged walking or standing is expected, a knee scooter may be a good adjunct for those activities.
Bigger surgeries require complete non-weight-bearing for the period of 2-6 weeks after surgery. During this period, the patient usually requires a knee scooter or a wheelchair to get around. Crutches and a walker may be used only for transfers or hopping through short distances.
How do I take care of my operated limb at home?
There is no need to change the dressing at home. The dressing MUST be kept clean and dry at all times. Taking a shower, the patient should use a garbage bag or an over-the-counter plastic cast protector. The patient should use tape to seal the cover snugly to avoid water seepage into a plastic bag.
The operated limb should be kept elevated during the first several days to minimize swelling. During the daytime, sitting in a recliner with the foot elevated is preferred overhanging it down. At night, the leg can be elevated and supported using 2-3 pillows. It is important that pillows are placed underneath the calf while leaving the heel free of excessive pressure as it is sensitive to pressure sores.
How soon can I start the postoperative motion exercise?
Each patient will be advised about motion exercise individually. Patients receiving reconstructive surgery will need to keep the operated part immobilized in a cast, a boot, or a post-op shoe. It is acceptable to do gentle isotonic exercise in the areas outside the surgery such as the knee, hip, abdomen, back, and upper extremities.
For arthroscopic procedures, patients may be able to start range-of-motion exercise as soon as the next day after surgery. Motion is important to decrease the formation of scar tissue within the joint. Patients are usually instructed to remove the postoperative boot or shoe during the exercise. It is crucial to put it back on correctly especially making sure the heel is all-the-way in the heel counter of the shoe or boot.
How soon can I get back to work or school?
Minimally invasive surgery (MIS) and arthroscopic surgery are usually associated with only mild pain. Whenever the patient can tolerate pain without using narcotics, usually 3-5 days after surgery, sedentary work or school activities from home may be resumed. More involved surgeries will usually require the patients to be off from work longer, especially if more strenuous activities are required.
How soon can I start driving again?
With automatic transmission cars, patients having a left-side surgery may be able to drive whenever pain is under control without the use of narcotics typically 2-3 days for MIS bunion or hammertoe corrections and 2-6 weeks after bigger surgeries.
Patients having right-side surgery will not be able to drive until a boot or splint is removed and 50% weight-bearing is tolerable. This can vary from 3 days after a MIS hammertoe correction to 8 weeks after an ankle fusion.
Regardless of the doctor's recommendations, prior to the return of driving, patients receiving surgery must feel confident in their vehicle control, have a partner to assist in unexpected situations, and have tried maneuvering a vehicle in safe areas.
Author: Phinit Phisitkul, MD
What should I do if I have concerns or problems after surgery?
After surgery, there will be plenty of time for patients and families to discuss any concerns. Patients should feel free to call the office at 605-217-2667 if additional questions arise.
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